UNIVERSITY  OF  CALIFORNIA,  SAN  DIEGO 


3  1822  01947  0202 


^  LIBRARY 


~N 


V_ 


UNN6RSITY  OF 
CAUFORNIA 

SAN  oicao 


UNIVERSITY  OF  CALIFORNIA   SAN  DIEGO 


3  1822  01947  0202 


\f 


C^'^ 


THE  snrrvsc!:  nc?:ooL,  w.  v.  M. 
130  ccLur.'.::-.':;  Avirrjs 

B03T0:i 


MILITARY  HYGIENE 


THE  ELEMENTS  OF 
MILITARY  HYGIENE 

ESPECIALLY  ARRANGED  FOR  OFFICERS 
AND  MEN  OF  THE  LINE 


BY 


y'Lc 


p.  m;>shbuen 

MAJOR,  MEDICAL   CORPS,  U.  S.  ARMY 


BOSTON  AND  NEW  YORK 
HOUGHTON  MIFFLIN  COMPANY 

1909 


COPYRIGHT,  1909,  BY  PERCY  M.  ASHBURN 


ALL  RIGHTS  RESERVED 


PREFACE 

There  can  be  little  or  no  doubt  that  the  sanitation  of 
the  army  would  be  greatly  improved  if  line  officers 
and  enlisted  men  should  become  more  interested  in  the 
subject,  and  cooperate  more  freely  and  intelligently 
with  medical  officers  in  the  efforts  to  promote  it. 

This  book  is  written  in  the  hope  that  it  may  both 
inform  and  interest  them  and  so  gain  for  the  medical 
officer  the  sympathy  and  cooperation  that  he  always 
needs,  but  now  too  seldom  has.  It  is  also  hoped  that 
medical  officers  themselves,  especially  those  of  the 
volunteer  service  and  militia,  may  find  the  book  useful 
in  their  dual  capacities  of  administrators  and  teachers. 


CONTENTS 

PART  I.  — THE  RECRUIT  AND  HIS  ENVIRON- 
MENT 

I.  The  Recruit 3 

n.  Persoxai.  Htgiexe 20 

III.  Foods  and  their  Preparation     .        .        .33 

IV.  The  Hygiene  of  the  Barracks       .        .        54 
V.  Camps 73 

VI.  The  Hygiene  of  Moving  Troops     .         .       101 
VII.  The  Hygiene  of  Hot  and  Cold  Climates   120 

PART  IL  — THE   CAUSES   OF  DISEASE 

VIII.  The    Remote    or    Predisposing    Causes    of 

Disease 141 

IX.  The    Immediate    or    Exciting    Causes    of 

Disease   .......       156 

X.  Disease  Carriers 180 

PART   III.  —  THE  PREVENTION  AND 
CONTROL   OF   EPIDEMICS 

XI.  The  Defenses  against  Disease  in  General    199 
XII.  Typhoid  and  other  Water-Borne  Diseases    213 

XIII.  Air-Borne  and  Fomites-Borne  Diseases     .  239 

XIV.  Insect-Borne  Diseases       ....       257 
XV.  Venereal  Diseases 281 

Index 301 


PART  I 

THE  RECRUIT  AND  HIS 
ENVIRONMENT 

"Health  and  a  good  constitution  are  better  than  all  gold;  and  a 
strong  body  than  wealth  without  measure." 

EccLESiASTicus  30 :  15. 


MILITAKY  HYGIENE 


CHAPTER  I 

THE  RECRUIT 

One  of  the  principal  factors  in  military  hygiene  is 
the  individual  soldier,  or,  as  he  comes  from  civil  life, 
the  recruit.  If  he  enters  the  service  in  good  physical 
condition,  in  good  health,  and  with  sufficient  intelli- 
gence to  apprehend  and  apply  the  instruction  he  re- 
ceives in  military  hygiene,  the  problem  is  almost  half 
solved.  The  final  acceptance  or  rejection  of  recruits  now 
rests  almost  entirely  with  medical  officers ;  but  in  cer- 
tain ways  line  officers  exercise  a  considerable  influence 
in  the  matter :  in  the  acceptance  at  the  recruiting  station, 
and  in  requesting  special  authority  to  enlist  because  of 
special  qualifications.  For  these  and  other  reasons  it  is 
important  that  they  should  keep  well  informed  as  to  the 
requirements  necessary  and  the  qualifications  desirable  in 
recruits.  We  will  therefore  briefly  consider  some  of  these. 
The  age  limits  for  first  enlistments  are  from  eighteen 
to  thirty-five  years.  Preferably  men  should  be  chosen 
between  twenty-three  and  thirty  years.  Be- 
fore  the  age  of  twenty-three  years  most  ° 
men  are  immature,  their  muscles  are  not  hardened,  their 
hearts  not  so  strong,  their  minds  not  disciplined  by  expe- 
rience, their  appetites  and  emotions  not  under  control ; 
while  their  susceptibility  to  impressions  from  their  en- 
vironment is  such  as  to  make  it  undesirable  to  limit 
their  associations  exclusively  to  adult  unmarried  males. 


4    THE   RECRUIT  AND  HIS  ENVIRONMENT 

After  the  age  of  thirty  years  the  man's  habits  of  body 
and  mind  are  fixed,  he  takes  instruction  less  readily, 
his  body  may  have  begun  to  deteriorate,  particularly  if 
it  has  not  been  well  cared-for,  and,  in  many  instances, 
he  seeks  the  service  as  a  refuge,  after  failing  in  other 
walks  of  life.  Many  good  men  may  be  obtained  before 
the  age  of  twenty-three  and  between  the  ages  of  thirty 
and  thirty-five,  but  in  general  the  case  is  thought  to 
be  as  stated. 

The  size  of  the  recruit  is  not  a  matter  of  the  great- 
est importance,  provided  that  the  development  is  nor- 
mal  and  the  man  strong  and  active,  except 
as  it  applies  to  assigning  him  to  duty.  It 
is  obvious  that  a  very  large  and  strong  man  is  better 
suited  for  coast-artillery  work  than  for  the  cavalry,  and 
that  a  small,  wiry  man  is  in  that  respect  better  for  the 
cavalry.  The  proportions  of  weight  and  chest  measure- 
ments to  height  are  published  from  time  to  time  in 
general  orders,  and  those  proportions  usually  represent 
very  well  those  of  strong,  well-developed  men.  An  in- 
crease of  weight,  if  associated  with  great  breadth  of 
shoulder  and  large  chest  measurement,  is  not  necessarily 
harmful,  being  usually  indicative  of  strength  and  en- 
durance. The  sturdy,  stocky  Japanese  coolie  exemplifies 
this.  Obesity,  whereby  the  man  is  burdened  with  his 
own  weight,  is  of  course  objectionable.' 

^  The  following  table  copied  from  the  Medical  Eecord  of  September 
5,  1908,  and  compiled  from  the  data  of  the  Mutual  Life  Insurance  Co. 
of  New  York,  by  its  Chief  Medical  Director,  is  interesting  as  indicat- 
ing somewhat "  the  influence  of  overweight  and  underweight  on  vitality." 
The  weights  considered  normal  by  the  insurance  company  are  some- 
what in  excess  of  those  prescribed  by  the  War  Department,  the  in- 
orease  averaging  about  10  pounds  at  the  ages  25-29,  and  for  heights 


Chest 


THE  RECRUIT  5 

The  chest  should  be  freely  mobile,  that  is,  both  sides 
should  move  freely,  symmetrically,  and  equally,  in  ex- 
panding and  contracting.  The  measured 
chest  expansion  should  generally  corre- 
spond with  the  figures  published  in  the  general  orders ; 
yet  it  should  be  remembered  that  one  man  with  very 
ordinary  lung  capacity  may,  by  use  of  the  shoulder  and 

below  70  inches.  A  weight  20  per  cent  below  the  average  is  considered 
"  underweight,"  and  20  per  cent  above  the  average,  "  overweight." 

Table  showing  the  Percentage  of  Deaths  in  all  Classes,  and  some  Indi- 
vidual Diseases,  among  Overweights  and  Underweights,  and  the 
General  Experience  of  the  Mutual  Life  Insurance  Company. 


Causes  of  Death. 

Over- 
weights. 

Under- 
weights. 

General 
Experience. 

Claes  I.         General  Diseases  —  Acute     .     . 

Typhoid  fever 

Malarial  fever 

Influenza     

Class  II.        General  Diseases  —  Chronic 

Tuberculosis 

Cancer 

Diabetes 

Class  in.      Diseases  of  the  Nervous  System 

Cerebral      Congestion      and 

Hemorrliage,          Cerebral 

Softening,  Paralysis   .     . 

General  Paralysis  and   other 

forms  of  mental  alienation 

Class  IV.      Diseases     of    the    Circulatory 

System 

Organic  diseases  of  the  heart 
Class  V.        Diseases    of    the    Respiratory 

System 

Fiieumonia 

Class  VI.      Diseases  of  the  Digestive  Sys- 
tem       

Cirrhosis  of  Liver     .... 
Class  VII.     Diseases  of  the  Genito-urinary 

System 

Bright's  Disease  and  Nephri- 
tis     

Class  IX.     Diseases  of    Skin  and  Cellular 

Tissue 

Class  XI.      Old  age 

Class  XII.    Violent  causes 

Casualties 

Suicides       

Class  Xin.  ni-defined 

9.67 
4.00 
1.27 
1.47 

13.07 
2.93 
4.40 
3.40 

19.08 

14.14 

1.80 

10.01 
12.94 

8.54 
6.87 

lO.Gl 
3.47 

12.01 

11.07 

1.20 

None 

7.07 

4.20 

2.87 
2.G0 

9.28 
3.0G 
1.21 
2.04 
24..59 
16.98 
5.  .57 
0.G5 
.12.16 

8.47 

0.84 

11.69 
8.54 

15.78 
12.34 

8.54 
0.65 

7.42 

5.30 

0.47 
2.04 
5.57 
3.43 
2.14 
2.50 

8.90 

3.94    j 

1.24 

1.00 
19.56 
12.42 

4.18 

1.25 
17.44 

12.32 

1.30 

1185 
10.76 

11.86 
9.03 

10.19 
1.00 

8.78 

6.66 

0.50 
1.50 
7.42 
5.21 
2.20 
3.98 

6    THE   RECRUIT  AND   HIS  ENVIRONMENT 

back  muscles  and  retraction  of  the  abdomen,  show  an 
apparent  expansion  of  3^  inches,  while  his  companions 
with  a  capacity  as  great,  may,  through  ignorance  of 
tricks  or  of  what  is  desired,  show  only  1|  inches.  It  is 
desirable  that  the  chest  be  fairly  large,  to  afford  amjtle 
room  for  the  free  working  of  the  heart  and  lungs,  as  on 
such  finally  depend  both  strength  and  endurance.  A 
generally  well-developed  and  strong  man  will  show 
well-developed  and  prominent  chest  muscles. 

Certain  types  of  chest  frequently  indicate  a  predis- 
position to,  or  the  actual  existence  of,  disease,  and  de- 
mand careful  consideration  even  when  not  constituting 
actual  causes  for  rejection.  The  long,  narrow  chest,  with 
prominent  or  "  winged  "  shoulder-blades,  depressed  or 
flat  below  the  collar-bones,  and  forming  an  acute 
angle  at  the  divergence  of  the  ribs  below  the  breast- 
bone, frequently  marks  a  predisposition  to  consumption. 

A  large,  barrel-shaped  chest,  as  deep  from  front  to 
back  as  transversely,  and  showing  a  relatively  small 
movement,  is  often  associated  with  emphysema  and 
asthma. 

A  chest  more  prominent  on  one  side  than  on  the 
other  is  apt  to  be  associated  with  curvature  of  the  spine, 
or  old  or  chronic  pleurisy. 

Marked  prominence  or  depression  of  the  breast-bone, 
especially  if  associated  with  "beading,"  or  lumps  on 
the  ribs  near  the  breast-bone,  frequently  results  from 
rickets,  and  may  be  accompanied  by  other  bone  de- 
formities. 

The  abdomen  should  be  well  muscled,  and  firm  when 

. ,  ,  the  applicant  is  standing.    It  should  move 

easily  and  naturally  in  respiration,  should 

not  be  pendulous,  and  should  be  firm,  particularly  in 


THE  RECRUIT  7 

its  lower  parts,  just  above  the  groin.  Weakness  here 
will  be  indicated  by  a  bulging  if  the  patient  strains,  as 
at  stool,  or  if  he  stands  on  his  toes  and  coughs  hard. 
Such  bulging,  especially  if  it  be  marked  or  shows  a 
tumor-like  swelling,  indicates  a  predisposition  to,  or 
the  actual  existence  of,  a  hernia. 

The  umbilicus  or  navel  is  another  frequent  site  of 
hernia,  and  should  be  noted  in  that  connection,  as 
should  any  abdominal  scars  resulting  from  operations, 
as  for  appendicitis.  Another,  though  less  frequent,  site 
of  hernia  is  the  femoral.  This  is  shown  by  a  fullness 
or  swelling  in  the  lower  part  of  the  groin,  in  the  high- 
est part  of  the  thigh  rather  than  in  the  lowest  part  of 
the  abdomen. 

Large  masses  or  tumors  that  can  be  felt  through  the 
abdominal  wall,  or  that  can  be  seen  to  produce  in- 
equality or  fullness,  are  causes  for  rejection. 

Distention  or  prominence  of  the  veins  on  the  sur- 
face of  the  abdomen,  or  a  varicose  condition  of  them,  is 
generally  an  evidence  of  impaired  circulation  or  liver 
disease,  and  should  cause  rejection. 

Hemorrhoids,  or  piles,  while  apparently  not  con- 
nected with  the  abdomen,  are  the  result  of  distention 
of  the  rectal  veins,  and  may  be  due  to  liver  disease,  to 
abdominal  tumors,  to  constipation,  or  other  intra-ab- 
dominal conditions.  They  are  manifested  as  tumors, 
usually  of  a  bluisli  color,  within  or  about  the  anus,  which 
vary  in  size  from  that  of  a  small  pea  to  that  of  a  man's 
thumb.  Of  themselves  they  are  not  a  cause  for  rejection 
unless  of  large  size  or  producing  symptoms,  but  their 
presence  should  always  be  noted.  Internal  piles  are  not 
visible,  and  usually  make  their  presence  known  by  burn- 
ing or  irritation  in  the  rectum,  or  by  the  passage  of 


8    THE  RECRUIT  AND   HIS  ENVIRONMENT 

blood  in  the  stools.  In  examining  for  them,  note  should 
also  be  made  of  other  abnormal  conditions  of  or  about 
the  anus,  such  as  fissures  or  cracks  in  the  skin  and 
mucous  membrane ;  fistulas,  little  openings  near  the 
anus  from  which  there  may  be  a  slight  discharge  of  pus 
or  fecal  matter ;  or  abscesses  or  boils.  Any  of  these 
conditions  may  so  disable  the  man  as  to  unfit  him  for 
service. 

A  history  of  abdominal  trouble,  such  as  severe  indi- 
gestion, gallstone  colic,  vomiting  of  blood,  should  cause 
rejection. 

The  examination  of  the  head  is  very  important,  as 
revealing  defects  in  most  of  the  special  senses  and  as 
_,     J  offering  important  evidence  as  to  the  man's 

character,  habits,  and  abilities.  The  evi- 
dence on  the  latter  points  is  to  be  gained  largely  from 
the  shape  of  the  head  and  the  expression  of  the  features, 
and,  while  such  evidence  is  not  always  reliable,  certain 
heads  and  faces  are  so  distinctly  indicative  of  stupidity 
or  vice  that  there  should  be  no  hesitation  in  rejecting 
their  possessors.  Then,  too,  hideous  or  disgusting  de- 
formities should  at  once  cause  rejection,  for  the  sake 
both  of  the  victim  and  those  with  whom  enlistment 
would  associate  him,  even  though  they  are  not  of  a 
character  to  incapacitate  directly.  The  vision  and  hear- 
ing should  be  tested  in  strict  accordance  with  the  regu- 
lations governing  the  subject,  and  failure  to  meet  the 
requirements  is  cause  for  rejection. 

In  addition  to  the  test  for  vision,  however,  the  eyes 

should  be  examined  for  any  signs  of  inflammation,  red- 

_  ness,  watering,  drooping  of  the  lids,  scars 

or  deformities,  granulations,  styes  or  boils, 

undue  prominence  of  the  eyeball,  inability  to  move  the 


THE  RECRUIT  9 

eyes  in  all  directions,  and  discoloration  or  blurring  of 
the  cornea- 

The  ears,  in  addition  to  the  tests  for  hearing,  should 
be  examined  for  any  discharge,  whether 
watery  or  purulent,  and  if  present  it  should 
be  a  cause  for  rejection. 

The  nose  should  be  examined  as  to  its  freedom  from 
obstruction,  by  having  the  applicant  close  first  one  side 
and  then  the  other  with  his  fingers  and  then 
breathe  and  blow  through  the  free  side.  In- 
cidentally this  may  call  attention  to  a  foul-looking  dis- 
charge or  a  foul-smelling  breath,  either  of  which  may 
justify  rejection.  A  sunken  or  much  scarred  nose  is 
often  an  indication  of  syphilis,  while  a  red,  bulbous 
nose,  even  if  not  indicating  alcoholism,  is  sometimes  an 
indication  of  indigestion.  It  should  be  noticed  that  the 
man  habitually  breathes  through  his  nose. 

The  mouth  and  throat  should  always  be     _,     ^, 
»  ,,  .     J  •'  Mouth 

careiully  exammed. 

The  condition  of  the  teeth  is  the  first  point  to  be 
noted  here.  It  is  desirable  that  all  should  be  pre- 
sent and  good,  but  there  must  be  at  least 
enough  to  permit  of  proper  mastication  of 
the  food,  and  for  this  purpose  at  least  four  grinders 
are  demanded,  two  above  and  two  below,  and  so  dis- 
posed as  to  permit  their  effective  use.  Enough  of  the 
front  teeth  should  also  be  present  to  permit  of  the  bit- 
ing of  food  and  to  preserve  the  symmetry  of  the  face. 
At  times  men  are  accepted  with  no  upper  teeth,  but 
wearing  plates.  This  should  only  be  done  by  special 
authority  and  in  special  instances.  Insufficient  or  poor 
teeth  are  apt  to  produce  digestive  disturbances,  partic- 
ularly on  campaign,  when  hard  bread  may  be  issued, 


10    THE  RECRUIT  AND  HIS  ENVIRONMENT 

and  when  the  preparation  of  the  food  in  general  may 
not  be  as  good  as  in  garrison.  The  examination  of  the 
teeth  should  not  only  relate  to  their  presence  and  the 
presence  or  absence  of  cavities,  but  also  to  their  state 
of  cleanliness.  Neglected,  filthy  teeth  and  gums  may 
seriously  menace  the  general  health,  while  they  cer- 
tainly predispose  to  loss  of  teeth,  and,  in  many  instances, 
indicate  general  carelessness  or  filthiness.  Sores  or 
ulcerations  on  the  lips,  tongue,  gums,  or  inner  sides  of 
the  cheeks  should  be  carefully  noted,  as  they  may  in- 
dicate syphilis  or  other  general  disease,  and  should  at 
least  lead  to  further  and  more  careful  search  for  syphi- 
lis. The  same  remark  applies  to  milk-white  patches, 
seen  especially  on  the  tongue. 

In  ill-kept  mouths  the  gums  may  be  spongy  and  bleed 

spontaneously  or  on  pressure,  or  pus  may  exude  from 

_,  between  them  and  the  teeth ;  or  they  may 

be  greatly  retracted  and  expose  tjje  roots 

of  the  latter. 

In  these  and  other  cases  the  teeth  may  all  be  present, 
yet  in  such  poor  condition  as  to  forbid  proper  mastica- 
tion, or  to  threaten  their  early  loss. 

The  most  common  and  easily  detected  throat  trouble 
is  enlargement  of  the  tonsih.  This  condition  usually 
_,  indicates  a  liability  to  frequent  attacks  of 

sore  throat,  and  should  always  excite  in- 
quiries as  to  this,  and  while  not  necessarily  a  cause  for 
rejection,  unless  very  marked,  should  be  noted  as  a 
point  against  desirability.  Ulcers,  white  patches,  mem- 
branes, and  an  appearance  of  acute  inflammation  in 
the  throat,  should  cause  rejection. 

Hoarseness,  or  loss  of  voice,  or  cough,  should  at  least 
delay,  and  if  persistent  prevent,  acceptance. 


THE   RECRUIT  11 

Numerous  scars  on  the  tongue,  lips,  and  cheeks,  unless 
clearly  and  certainly  accounted  for  other-     _ 
wise,  should  cause  rejection  as  being  prob-  ° 

ably  due  to  bites  during  epileptic  fits,  or  to  syphilitic 
or  other  ulceration. 

Too  much  importance  should  not  be  attached  to  a 
coated  tongue,  but  a  raw-looking,  bright  red,  or  tremu- 
lous one  should  direct  careful  scrutiny  to  the  general 
condition  and  the  habits. 

Enlarged  lymphatic  glands,  or  "kernels,"  are  most 
frequently  noticed  in  the  neck  or  under  the  jaw.    They 
are  frequently  indicative  of  inflammation  or     - 
ulceration  in  other  nearby  regions,  espe- 
cially  the  mouth  or  throat,  and  their  pre-     *^ 
sence  should  lead  to  careful  examination  for  such  con- 
ditions ;  but  at  times  their  presence  is  indicative  of  a 
general  infection,  such  as  syphilis.   Usually,  if  the  en- 
larged glands  are  numerous,  or  the  enlargement  great, 
they  constitute  a  proper  cause  for  rejection.  When  the 
enlargement  is  localized  at  one  part  of  the  neck  only, 
it  points  to  an   infection  entering  at  a  part  near  it. 
Thus  such  a  gland  at  the  angle  of  the  jaw  may  be  due 
to  inflammation  of  a  tonsil  of  the  same  side  ;  one  under 
and  near  the  jaw  to  a  bad  tooth,  etc. 

The  scalp  should  be  carefully  examined  as  to  its 
cleanliness  and  general  care,  for  the  presence  of  lice, 
which  may  be  seen  as  such  or  may  be  re- 
vealed  by  the  "  nits  "  or  eggs,  little  whitish  '^ 

bodies  attached  firmly  to  the  hairs ;  for  ringworm, 
scabbiness  or  scald-head,  patchy  baldness,  wounds  or 
scars,  etc.  The  presence  of  vermin  is  a  cause  of  rejec- 
tion in  two  ways,  as  indicating  a  lack  of  personal  care, 
and  as  a  danger  to  be  introduced  into  crowded  barracks. 


12    THE   RECRUIT  AND  HIS  ENVIRONMENT 

Superficial  suppurative  scalp  diseases  should  generally 
cause  rejection,  as  being  contagious  or  as  being  caused 
by  scratching  excited  by  lice.  Patchy  baldness,  if  the 
patches  are  sharply  defined  and  the  skin  is  smooth, 
clean-looking,  and  not  scarred,  is  apt  to  be  harmless. 
If  the  skin  is  inflamed  and  scarred,  and  stumps  of 
broken  hairs  are  present,  it  should  cause  rejection.  Ir- 
regular and  incomplete  baldness  occurring  in  patches 
or  tracts,  giving  at  times  a  "  moth-eaten  "  appearance, 
is  most  apt  to  be  due  to  syphilis,  and  should  cause  care- 
ful examination  for  other  signs  of  that  disease. 

The  upper  limbs  should  be  examined  as  to  their  de- 
velopment and  musculature,  their  free  mobility  in  all 
joints  and  in  all  directions,  the  presence  of 
all  bones  and  joints,  and  a  reasonable 
amount  of  dexterity  and  strength.  Atrophy  or  wasting 
of  a  group  of  muscles  or  a  part,  inability  to  bend  or 
make  free  use  of  a  joint,  and  similar  defects,  should 
be  carefully  looked  for,  as  they  may  otherwise  be 
missed.  Loss  of  one  or  more  joints  of  a  finger,  swelling 
and  deformity  of  a  joint  (baseball  finger),  or  stiff  con- 
tracted fingers  are  not  uncommon,  and,  if  in  the  fourth 
or  fifth  fingers,  are  not  serious  matters,  though  they 
should  be  noted.  If  in  the  second  or  third  fingers,  the 
matter  is  more  serious,  yet  the  applicant  will  usually 
be  able  to  handle  a  gun  and  perform  his  other  duties. 
Loss  of  a  thumb  is  a  serious  defect,  and  in  most  instances 
would  justify  rejection.  All  deformities  from  badly 
united  fractures  or 'other  causes  should  be  noted,  and 
should  cause  rejection  unless  the  applicant  can  demon- 
strate his  ability  to  execute  the  movements  necessary 
in  the  performance  of  his  duties. 

The  legs  should  likewise  be  examined  as  to  their 


THE   RECRUIT  13 

development,  musculature,  size,  mobility,  etc.  The  ap- 
plicant should  be  required  to  move  all  the  -  , 
joints,  to  jump,  hop,  and  otherwise  demon- 
strate  his  ability  to  use  his  limbs.  Marked 
deformities,  such  as  clubfoot,  shortening  of  one  leg, 
stiffness,  marked  swelling  or  marked  limitation  of  mo- 
tion in  a  knee  or  hip,  should  at  once  cause  rejection. 
Less  marked  deformities,  such  as  knock-knee,  bow-legs, 
crooked  shins,  etc.,  need  not  cause  rejection  unless  man- 
ifestly interfering  with  the  free  use  of  the  limbs,  or 
rendering  the  subject's  appearance  ludicrous  or  unmili- 
tary.  Here,  again,  marked  wasting  of  a  part  or  of  a 
group  of  muscles  will  often  be  found  due  to  a  joint 
lesion,  a  paralysis,  or  other  nervous  trouble,  that  would 
serve  to  disqualify  the  applicant.  In  addition  to  these 
defects,  common  to  both  arms  and  legs,  the  lower  ex- 
tremities are  subject  to  other  affections  rarely  or  never 
seen  in  the  upper. 

Varicose  or  dilated  veins  are  often  seen.  They  usu- 
ally show  as  swollen,  bluish,  and  more  or  less  tortuous 
vessels  beneath  the  skin,  and  may  be  individually  as 
large  as  a  man's  finger.  They  are  most  commonly  seen 
on  the  lower  legs,  but  are  not  very  rare  in  the  space  be- 
hind the  knee,  and  may  extend  up  the  inner  side  and 
front  of  the  thigh  to  the  groin.  If  marked,  they  should 
cause  rejection.  If  only  slight,  and  in  otherwise  desira- 
ble applicants,  they  may  be  passed,  but  should  always 
be  noted.  At  times  they  cause  the  appearance  and  per- 
sistence of  very  chronic  ulcers,  which  occasionally  bleed, 
pain,  or  otherwise  disable  the  man.  Such  ulcers  are  es- 
pecially apt  to  show  on  the  front  or  to  the  inner  side  of 
the  lower  half  of  the  leg.  They  are  long  in  healing,  are 
apt  at  any  time  to  break  open  again,  and  when  healed 


14    THE  RECRUIT  AND  HIS   ENVIRONMENT 

usually  present  brownish,  discolored  scars.  Such  ulcers, 
or  such  scars  if  accompanied  by  varicose  veins,  should 
cause  rejection.  The  legs  are  especially  prone  to  chronic 
ulcerations^  which  may  be  caused  by  syphilis,  tubercu- 
losis, leprosy,  and  other  infections.  In  general  these  are 
causes  for  rejection. 

A  rough,  nodulated,  tender  shin-bone  is  not  an  un- 
usual sign  of  syphilis. 

The  feet  require  particularly  careful  examination,  as 
on  their  integrity,  usefulness,  and  strength  (or  what  we 
might  call  their  durability)  depends  a  large  part  of  the 
man's  capacity  for  "  soldiering."  The  best  known  and 
probably  the  least  important  of  the  foot-ills  is  corns. 
They  are  best  known  because  most  persons  at  some  time 
have  at  least  one,  and  they  are  one  of  the  least  impor- 
tant ills  because  in  most  instances  they  cause  not  even 
serious  inconvenience,  and  they  usually  disappear  with 
the  use  of  properly  fitting  shoes  and  ordinarily  good 
care  of  the  feet. 

If  numerous  and  painful,  however,  or  if  soft  corns, 
situated  between  the  toes,  they  may  justify  rejection. 

Sweating  feet,  which  soften,  blister,  redden,  and  burn, 
may  cause  rejection,  as  they  are  not  apt  to  stand  much 
marching. 

Stinking  feet  may  justify  rejection  in  most  instances, 
as  constituting  a  nuisance  in  barracks. 

Bunion,  an  inflammatory  and  deforming  joint-affec- 
tion, usually  at  the  base  of  the  great  toe,  will,  if  very 
marked,  disqualify. 

Hammer-toe,  a  condition  in  which  a  toe  is  flexed  and 
the  end  presses  on  the  floor,  while  a  knuckle  projects 
above,  is  very  apt  to  cause  lameness  and  may  justify 
rejection. 


THE   RECRUIT  15 

Overlapping  toes  may  disqualify  in  a  somewhat  simi- 
lar manner. 

Deformities  of  the  arch  of  the  foot  are  very  impor- 
tant. It  may  be  too  high,  so  that  the  weight  is  borne  on 
the  ball  of  the  foot  and  the  heel,  the  intermediate  parts 
remaining  clear  of  the  ground.  This  is  a  relatively  rare 
condition,  but  may  disqualify.  A  common  condition  is 
the  opposite,  ov  flat  foot,  wherein  the  whole  length  and 
breadth  of  the  foot  touches  the  ground  and  the  arch  is 
almost  or  entirely  obliterated.  Such  a  foot  in  a  white 
man  is  usually  a  poor  marching  foot,  and,  unless  the 
applicant  is  a  desirable  man  and  states  that  he  is  a  good 
walker,  and  that  the  foot  never  gives  him  trouble,  it 
should  cause  rejection.  When  passed,  its  existence 
should  always  be  noted,  in  case  the  man  should  be  dis- 
charged for  it  later.  The  condition  is  more  common  but 
less  important  in  negroes,  but  it  may  cause  trouble  in 
them  also,  particularly  in  the  course  of  long  marches. 

Another  type  of  weak  foot  is  not  really  flattened  but 
tends  to  rotate  outward,  thus  bringing  the  inner  margin 
of  the  foot  nearer  to  the  ground  and  more  directly 
under  the  weight  of  the  body,  where  a  greater  weight 
comes  upon  it,  causing  it  to  tire  and  eventually  to  break 
down  and  become  flat.  It  may  justify  rejection. 

The  genitals  should  be  well-formed  and  normal. 
Both  testicles  should  be  present  and  in  the  scrotum ; 
it  should  be  possible  for  the  applicant  to  . 

retract  his  foreskin,  and  the  penis  should 
not  show  gross  deformities,  such  as  the  opening  of  the 
urethra  being  placed  far  back  from  the  end.  Scars  on 
the  penis  should  prompt  investigation  as  to  their  na- 
ture, whether  syphilitic,  chancroidal,  or  otherwise.  The 
man  should  be  required  to  express  the  contents,  if  any, 


16    THE  RECRUIT  AND  HIS   ENVIRONMENT 

from  the  urethra.  Pus  should  at  once  cause  rejection, 
as  should  any  ulcers  or  sores  on  the  penis,  redness, 
puffiness,  or  signs  of  marked  irritation  about  the 
urethra,  or  the  presence  of  vermin,  commonly  known  as 
crab-lice.  Inflammation  of  the  glans  beneath  the  fore- 
skin, and  venereal  warts,  while  not  in  themselves  dis- 
abling, will  often  justify  rejection  as  capable  of  exciting 
suppurative  buboes,  and  as  resulting  from  venereal 
disease  or  uncleanliness,  or  both. 

Buboes  are  swollen  and  inflamed  lymphatic  glands, 
and  are  found  in  the  groin.  They  may  be  single  or 
multiple,  on  one  or  both  sides,  and  may  vary  in  size 
from  that  of  a  small  cherry  to  that  of  an  orange. 
While  not  all  groin  buboes  are  venereal,  the  great  ma- 
jority of  them  in  applicants  for  enlistment  are,  and 
they  justify  rejection,  even  though  the  applicant  insists, 
as  he  probably  will  if  his  venereal  disease  is  not  plainly 
evident,  that  they  are  due  to  "  strain." 

Varicocele  is  a  condition  of  enlargement  of  the  veins 
of  the  scrotum.  It  is  most  often  found,  and  is  apt  to  be 
most  marked,  on  the  left  side.  The  condition  f  i-equently 
causes  no  symptoms,  though  it  is  often  said  to  cause 
pain,  and  is  apt  to  be  pleaded  as  an  excuse  from  arduous 
duty.  If  present,  it  need  not  cause  rejection  unless  very 
marked  or  unless  the  applicant  says  that  it  produces 
symptoms,  but  when  passed  it  should  always  be  noted, 
and  the  applicant  be  made  to  agree  to  be  operated  upon 
if  symptoms  begin,  or  if  the  condition  comes  to  interfere 
at  all  with  his  duties. 

Hydrocele  is  an  enlargement  of  the  scrotum,  usually 
on  one  side,  caused  by  an  outpouring  of  clear  fluid  into 
the  membranous  sac  surrounding  the  testicle.  It  pro- 
duces a  tense,  painless,  and  often  translucent  swelling, 


THE   RECRUIT  17 

which  may  at  times  be  hard  to  distinguish  from  a  tumor 
of  the  testicle  or  a  hernia.  Any  one  of  the  conditions, 
however,  may  suffice  to  exclude  the  applicant  in  time  of 
peace. 

While  not  much  reliance  can  be  placed  on  an  appli- 
cant's denial  of  venereal  disease  and  his  assertions  as  to 
perfect  genital  health,  he  should  be  questioned  on  the 
subject,  and  should  be  asked  as  to  the  frequency  of 
urination  and  his  ability  to  pass  a  good  stream  of  urine. 
Dribbling  or  inability  to  pass  a  good  stream,  or  to  hold 
or  control  his  urine,  should  cause  rejection. 

The  skin  will  necessarily  be  noticed  and  examined 
during  the  examination  previously  described.  One  of 
the  first  and  most  important  points  to  be  «,  . 
noted  is  its  cleanliness.  A  dirty,  foul,  stink- 
ing skin  usually  indicates  the  type  of  man  not  wanted  in 
our  army,  and  it  justifies  rejection  without  further  exam- 
ination. Certain  men,  however,  appear  with  their  skins 
soiled  with  sweat  and  dust  simply  because  of  lack  of 
opportunities  for  cleanliness,  and  if  their  general  appear- 
ance and  their  stories  indicate  that  they  are  desirable 
men,  they  should  be  given  an  opportunity  to  bathe  and 
then  be  examined.  It  must  not  be  forgotten  that  a 
filthy  man  may  bathe  for  examination,  but  reveal  his 
usual  habits  by  his  linen.  However  revealed,  filthy 
habits  should  cause  rejection. 

A  skin  showing  the  marks  of  severe  and  generalized 
scratching  is  usually  indicative  of  disease  or  vermin 
infestation,  and  is  therefore  objectionable. 

All  forms  of  contagious  skin  diseases,  such  as  ring- 
worms and  syphilitic  eruptions,  should  cause  rejec- 
tion, or,  in  the  person  of  an  enlisted  man,  call  for 
prompt  treatment.  As  the  line  officer  cannot  be  ex- 


18    THE  RECRUIT  AND  HIS  ENVIRONMENT 

pected  to  differentiate  such  affections,  he  will  be  on  the 
safe  side  if  he  treats  them  all  as  suspicious,  though  he 
should  if  possible  learn  to  recognize  acne,  the  common 
"  pimply"  eruption  seen  on  the  chests,  backs,  and  faces 
of  many  young  men.  It  is  usually  not  a  severe  affec- 
tion, and  as  it  may  coexist  with  good  health  and  good 
habits,  it  should  not  cause  rejection. 

While  a  few  men  who  are  not  really  physically  fit 
get  into  the  service,  there  are  a  good  many  more  who 
_,,  are    morally  or  mentally  unfit,   and  they 

are  the  men  who  later  spend  much  of  their 
time  in  the  guard-house  or  who  swell  the 
number  of  desertions.  Against  this  class  of  men  the 
recruiting  officer  works  at  a  disadvantage.  Unfortu- 
nately, almost  any  man,  no  matter  what  his  character, 
can  get  letters  of  recommendation,  so  that  such  letters 
are  really  of  little  importance,  and  the  officer  is  forced 
to  rely  largely  on  his  own  ability  to  judge  men  by  ap- 
pearances, —  a  notoriously  unsafe  thing,  and  an  almost 
impossible  thing  for  some  individuals.  Some  aid  is  ob- 
tained, though,  by  attention  to  the  applicant's  general 
bearing,  his  facial  expression,  his  quickness  of  appre- 
hension, the  condition  of  his  person  and  his  clothing, 
and  such  evidences  of  alcoholism,  venereal  disease,  good 
habits,  and  truthfulness  as  the  examination  may  bring 
out.  When  a  man  declares  that  he  never  drinks,  although 
his  breath  is  strong  with  alcohol  at  the  time,  or  that  he 
has  never  had  venereal  disease,  though  he  shows  a  scar 
on  his  penis  and  another  in  his  groin,  or  has  a  suppura- 
tive bubo  that  he  says  is  due  to  a  strain,  the  inference 
is  fair  that  he  is  a  liar  and  undesirable. 

Under  our  system  of  voluntary  enlistment,  and  as 
long  as  there  are  plenty  of  applicants,  it  is  better  to 


THE   RECRUIT  19 

reject  all  those  about  whom  the  officer  cannot  feel  well 
satisfied  ;  and  this  whole  chapter  is  based  on  such  an 
assumed  condition  of  affairs.  In  time  of  war,  or  when 
the  supply  of  applicants  for  enlistment  is  not  up  to  the 
demands,  many  men  can  be  passed  who  would  be  ex- 
cluded under  our  assumed  conditions ;  but  in  all  such 
cases  they  should  only  be  passed  by  medical  officers  ex- 
ercising great  care,  and  every  defect  should  be  noted, 
both  as  to  its  presence  and  its  degree,  as  constituting  a 
possible  ground  of  application  for  a  pension. 

The  man  being  in  the  service  and  any  defect  coming 
to  his  commanding  officer's  attention,  he  should  be  re- 
ferred to  a  medical  officer  to  have  it  corrected  if  prac- 
ticable, but  at  any  rate  to  have  it  noted,  in  the  interests 
of  justice  to  the  man  and  to  the  government,  and,  if 
it  be  sufficiently  serious,  to  have  the  man  discharged 
before  he  breaks  down  in  time  of  stress,  with  possibly 
serious  results. 

In  this  as  in  nearly  all  respects,  the  medical  officer's 
duties  can  be  performed  more  promptly  and  effectively 
if  he  has  the  cooperation  of  the  line  officer. 


CHAPTER  II 

PERSONAL   HYGIENE 

The  recruit  having  been  accepted  for  the  service  in 
good  health  and  good  physical  condition,  it  is  his  duty 
to  himself  and  to  his  government  to  maintain  those 
desirable  conditions  unchanged  except  for  the  better, 
if  it  be  possible  for  him  to  do  so.  It  will  be  possible  in 
large  part,  if  he  is  taught  how  to  do  it,  and  it  is  there- 
fore incumbent  upon  his  officers  to  teach  him  at  least 
the  rudiments  of  personal  hygiene,  and  those  rudiments 
may  be  summarized  as  follows  :  — 

First  of  all  he  must  be  taught  the  importance  of  an 
abundance    of   fresh  air   both   day   and   night,   as   a 
.  health-giving,  strength-producing,  and  life- 

prolonging  measure.    He  must  know  that 
"colds,"  sore-throat,  pneumonia,  and  kindred  troubles 
are  not  caused  by  cold  air,  but  by  micro-organisms; 
that  those  micro-organisms  are  much  more  numerous 
and  much  more  apt  to  harm  him  in  a  warm,  "  close  " 
room,  with  impure  and  rebreathed  air,  than  in  the  open ; 
and  that  such  diseases  are  more  common  in  cold  weather, 
because  in  his  efforts  to  exclude  the  cold  man  is  apt  to 
include  such  air.    The  habit  of  breathing  deeply  and 
thoroughly  changing  the  air  in  the  lungs  is  imparted  to 
him  by  his  gymnastic  and  military  drills,  and  is  helpful. 
He  should  also  learn  early  that  his  rest  is  important 
and  should  be  taken  regularly,  in  order  to 
preserve  his  health  and  enable  him,  for  that 
reason,  to  do  without  it  more  easily  when  the  neces- 


PERSONAL  HYGIENE  21 

sity  arises.  He  should  get  eight  hours  of  sleep  in  each 
twenty-four,  while  four  hours  more  should  be  allowed 
for  meals  and  short  rests,  changing  of  clothing,  etc.  In 
the  remaining  twelve  hours  he  should  do  his  work  and 
his  play.  Regularity  in  rest  and  work  is  of  great  im- 
portance, and  that  is  probably  one  reason  that  so  many 
men  improve  rapidly  in  physique  after  entering  military 
service.  On  the  other  hand,  it  is  debilitating  and  de- 
moralizing to  steal  the  hours  from  sleep  for  drinking 
and  venery.  It  is  desirable  that  the  night's  rest  be  taken 
in  clothing  different  from  that  used  in  the  daytime,  and 
the  latter  should  be  allowed  to  air.  Every  man  should 
possess  and  use  night-clothing,  and  the  not  uncom- 
mon habit  of  sleeping  in  the  underclothing  should  be 
discouraged.  No  man  should  have  a  "  barrack  odor  " 
clinging  to  him,  and,  if  ventilation  and  clothing  are 
looked  after,  he  will  not. 

The  most  beneficial  exercise  is  that  obtained  incident- 
ally to  work  or  recreation.  Exercise  taken  purely  as 
such  is  usually  repugnant,  and  takes  on  the 
aspect  of  work  to  men  who  feel  that  they 
already  have  an  abundance  of  it.  It  should  therefore  be 
taken  with  some  other  incentive  than  is  furnished  by 
official  orders.  Baseball  games,  field  sports,  and  other 
athletic  competitions  should  be  encouraged,  and  the 
effort  should  be  made  to  interest  and  include  all  the  men 
in  them,  and  not  merely  a  baseball  nine  and  a  few  ex- 
pert athletes  in  each  post.  The  objects  to  be  attained  by 
exercise  are  the  increase  of  the  strength  of  the  heart 
and  the  capacity  of  the  lungs,  on  which  two  depend  en- 
durance, the  increase  of  muscular  strength,  of  nervous 
stability  and  control,  of  digestion  and  assimilation,  and 
keeping  the  emunctories  (the  channels  of  waste  excre- 


22    THE  RECRUIT  AND  HIS  ENVIRONMENT 

tion,  such  as  the  skin,  kidneys,  and  bowels)  active. 
No  form  of  exercise  at  present  encouraged  in  the  army 
fails  to  promote  some  of  these  ends,  so  they  are  all 
good. 

Cleanliness  of  person,  clothing,  and  bedding  should, 
and  usually  does,  become  a  habit  of  life  with  the  soldier ; 
-,,  ..  but  some  men  require  much  watching  and 
admonition  to  make  it  become  so,  and  fre- 
quent  inspections  should  be  made,  in  order 
that  the  admonition  may  not  be  wanting.  In  general,  it 
may  be  stated  that  dirty  soldiers  are  either  recruits  or 
men  who  through  drink  or  vicious  habits  have  suffered 
in  their  self-respect.  Body  lice  are  rarely  seen  in  our 
service  except  in  guard-houses,  where  they  may  be  in- 
troduced by  captured  deserters  or  other  prisoners.  Bed- 
bugs are  occasionally  found,  and  head-lice  and  itch 
less  frequently.  All  of  these  pests  should  be  carefully 
watched  for  and  exterminated  when  found,  as  not  only 
are  they  disgusting  in  themselves,  and  indicative  of 
careless  or  filthy  habits,  but  it  seems  quite  possible 
that  they  may  act  at  times  as  carriers  of  disease.  Bed- 
bugs, when  once  introduced  in  barracks,  are  at  times 
very  hard  to  dislodge,  particularly  if  the  buildings  are 
old  and  show  many  cracks  in  the  walls. 

Personal  cleanliness  should  be  understood  as  includ- 
ing the  exclusive  use  of  one's  own  linen  and  toilet 
articles.  Disease  may  be  transmitted  readily  by  the 
indiscriminate  or  common  use  by  several  persons  of  the 
same  towels,  sponges,  wash-cloths,  combs,  hair-brushes, 
shaving-brushes,  etc.  Among  diseases  which  are  most 
commonly  transmitted  by  these  means  are  itch,  ring- 
worms and  other  skin  diseases,  granulated  eyelids, 
gonorrheal  infection  of  the  eyes,  body  vermin,  and. 


PERSONAL  HYGIENE  23 

occasionally,  such  infectious  diseases  as  typhoid  fever 
or  smallpox. 

It  is  not  necessary  that  a  man  should  bathe  his  body 
daily  unless  he  is  engaged  in  particularly  arduous  or 
dirty  work,  but  he  should  bathe  at  least  twice  a  week 
in  summer  and  once  a  week  in  winter,  and  as  much 
oftener  as  is  necessary  to  keep  his  skin  clean  and  free 
from  all  odor,  especially  from  the  feet,  crotch,  genitals, 
and  armpits,  and  particular  attention  should  be  given 
to  those  parts.  Once  or  twice  a  week,  or  oftener  if 
necessary,  the  washable  clothing,  —  shirts,  drawers, 
and  socks, —  should  be  changed,  and  fresh  put  on. 
More  frequent  baths  and  changes  of  course  do  no  harm, 
but  they  should  not  ordinarily  be  demanded. 

The  soldier  cannot  well  give  too  much  attention  to 
his  feet^  as  he  thereby  keeps  them  in  good  condition 
and  directly  increases  his  value  as  a  soldier.  Any  trou- 
ble with  them  should  at  once  be  corrected  by  the  man, 
by  means  of  bathing,  clean  socks,  properly  fitting  shoes, 
proper  nail-trimming  and  cleaning ;  or,  if  of  a  kind  not 
corrected  by  such  means,  it  should  be  reported  to  the 
surgeon. 

The  hands  are  not  subject  to  so  many  disabilities  as 
the  feet,  but  they  should  be  kept  clean  and  sound,  the 
nails  clean  and  trimmed,  and  it  should  become  a  matter 
of  routine  to  wash  them  before  taking  food,  as  diseases 
so  diverse  as  lead-poisoning  and  typhoid  fever  may 
result  from  the  neglect  of  such  a  practice. 

The  scalj)  should  not  be  neglected  in  the  general 
cleaning,  and  its  cleansing  is  facilitated  by  having  the 
hair  short. 

Bedding  should  be  aired  and  bed  linen  changed 
weekly. 


24    THE  RECRUIT  AND  HIS   ENVIRONMENT 

The  clothing  issued  by  the  government  is  nearly 
always  of  good  quality,  and  is  furnished  in  sufficient 
quantity  to  enable  the  soldier  to  be  always 
°  comfortably,  seasonably,  neatly,  and  cleanly 
attired  in  a  uniform  and  soldierly  manner,  and  as  much 
should  always  be  demanded  of  him.  He  has  to  pay  for 
his  laundry-work,  and  he  should  have  enough  done  to 
meet  all  the  requirements  indicated  above. 

The  individual  soldier  has  relatively  little  to  do  with 
the  choice  of  his  food,  and  the  subject  will  be  dealt 
with  at  greater  length  in  a  later  chapter. 
°  He  has  all  to  say,  however,  as  to  how  he 
shall  eat  what  is  served  to  him,  and  he  should  be  taught 
to  avoid  gluttony,  to  eat  with  an  observance  of  the 
decencies,  to  chew  his  food  thoroughly  and  eat  slowly, 
to  be  as  regular  in  his  hours  and  habits  of  eating  as 
his  duties  permit,  and  to  avoid  the  use  at  meals  of  the 
enormous  quantities  of  liquid,  particularly  coffee,  in 
which  he  seems  to  find  delight.  A  pint  of  water  may  be 
taken  with  a  meal  without  harm,  but  a  pint  of  coffee  is 
apt  to  cause  some  disturbance,  while  a  quart  is  much 
more  apt  to  do  so ;  and  the  fact  that  so  little  demon- 
strable harm  does  result  is  probably  due  to  the  good 
general  physique  and  surroundings  of  the  soldier.  Many 
soldiers,  especially  young  ones,  are  prone  to  indulge,  at 
almost  every  opportunity,  in  the  eating  of  fruits  and 
pastries,  with  less  regard  to  the  quality  than  to  the 
quantity.  This  tendency  is  lessened  by  a  good  company 
mess,  and  it  should  be  discouraged  as  apt  to  lead  to 
digestive  disturbances. 

Regularity  of  the  bowels  should,  if  practicable,  be 
established  and  maintained  by  regular  habits,  good 
food,  the  use  of  fruits  and  bulky  foods,  such  as  vege- 


PERSONAL  HYGIENE  25 

tables  and  oatmeal,  and  by  exercise.  Irritating  or 
highly-seasoned  foods  should  be  used  sparingly,  if 
at  all. 

Considerable  observation  affords  foundation  for  tlie 
belief  that  the  mouth  is  probably  the  most  generally 
neglected,  from  a  sanitary  standpoint,  of  all  „, 
the  parts  of  the  soldier's  body,  and,  as  -_  , 
many  diseases  may  result  from  such  neg- 
lect, it  is  important  that  company  officers  should 
keep  this  fact  in  mind  and  endeavor  to  correct  it.  In- 
digestion, malnutrition,  toxic  poisoning,  sore  throat, 
tuberculosis,  pneumonia,  local  gangrene,  lead-poison- 
ing, syphilis,  mercurial  salivation,  loss  of  teeth,  anemia, 
and  other  diseases,  accidents,  or  injuries  are  caused, 
promoted,  or  aggravated  by  neglect  of  the  mouth  and 
teeth ;  yet,  in  spite  of  this,  and  of  the  additional  facts 
that  the  dental  art  is  everywhere  practiced  and  has 
been  brought  to  a  high  degree  of  efficiency,  and  that 
among  most  people  of  education  cleanliness  of  the  mouth 
is  practiced  as  a  matter  of  routine,  like  face  and  hand- 
washing, a  surprising  number  of  soldiers  neglect  their 
mouths  shamefully.  They  either  do  not  use  tooth- 
brushes at  all,  or  they  use  them  so  infrequently  or  so 
poorly  as  to  do  no  good  ;  they  allow  teeth  to  decay, 
without  seeking  any  relief  until  extraction  is  the  only 
procedure  desired  or  available  ;  and  they  allow  the 
gums  to  become  retracted,  spongy,  bleeding,  and  tender, 
and  seek  no  relief  until  the  mouth  becomes  painful  or 
ulcerated.  The  reasons  for  this  are  probably  twofold  ; 
first,  ignorance ;  second,  the  fact  that  the  government 
employs  dentists  to  treat  the  teeth  of  the  soldiers,  but 
employs  them  in  such  numbers  that  a  given  post  may 
be  without  the  services  of  one  for  a  year  and  a  half,  or 


26    THE  RECRUIT  AND  HIS  ENVIRONMENT 

longer,  at  a  time.  Meanwhile,  the  man  delays  going  to 
a  dentist  whom  he  will  have  to  pay  for  his  services, 
hoping  that  the  army  dentist  will  be  at  the  post  soon ; 
and,  knowing  that  the  post  surgeon  is  not  a  dentist,  he 
does  not  report  to  him.  Every  company  commander 
should  therefore  instruct  his  men  somewhat  as  fol- 
lows :  — 

1st.  Every  man  should  have  a  tooth-brush,  and 
should  so  use  it  at  least  twice  daily,  and  preferably 
oftener,  as  to  remove  from  the  teeth  and  gums  all  par- 
ticles of  food  or  other  foreign  matter,  brushing  away 
from  the  gums  and  in  all  cracks  and  crevices. 

2d.  That  he  should  after  each  meal  remove  from 
between  the  teeth,  with  a  wooden  or  quill  tooth-pick, 
or  with  a  thread,  any  pieces  of  meat  or  other  food,  and 
not  allow  it  to  remain  and  putrefy. 

3d.  That  he  should  promptly  consult  a  dentist  or  a 
medical  officer  about  any  trouble  arising  in  the  teeth 
or  gums.  The  medical  officer  can  at  least  give  him 
proper  advice,  and  in  many  instances  proper  treat- 
ment. 

Much  harm  is  done  by  careless  spitting,  urination, 
asd  defecation  in  improper  places,  by  men  ignorant  of 
cj    ■*.*■•  the  harm  they  may  thus  do.  Because  appar- 

_  .  ently  healthy  themselves,  it  does  not  occur 
T  fl  nf  ^^  them  that  they  may,  in  answering  a  per- 
,  fectly  natural  call,  transmit  disease  to  otli- 

I6I1S65 

ers.  Yet,  as  will  be  shown  in  other  places, 
they  may  be  giving  off  the  organisms  causing  typhoid 
or  other  infections  in  their  urine  or  feces,  or  those 
causing  diphtheria,  tuberculosis,  or  other  disease  in 
their  spit,  and  such  organisms  may  then  soak  or  wash 
into  the  water-supply,  or  may  be  carried  as  dust  or 


PERSONAL  HYGIENE  27 

mud  to  the  mouths,  hands,  food,  or  breath  of  healthy- 
persons,  and  so  infect  them.  Decency  and  patriotism 
should  prompt  a  man  to  show  as  much  regard  for  the 
health  of  his  comrades  as  for  his  own. 

The  question  of  venereal  disease  will  be  dealt  with  in 
a  subsequent  chapter.  Much  of  it  could  be  avoided 
if  the  ignorance  and  misconception  regard- 
ing  sexual  life  could  be  dissipated.  Every 
man  should  know  that  sexual  continence 
is  compatible  with  perfect  physical  health,  while  its 
maintenance  is  far  greater  evidence  of  character  and 
"  manliness  "  than  is  the  association  with  prostitutes, 
the  abasement  of  virtuous  girls,  or  the  lowering,  self- 
respect-destroying  and  demoralizing  practice  of  mastur- 
batiap.  The  sexual  organs  and  sexual  desire  are  placed 
in  man  that  he  may  procreate  and  replenish  the  race ; 
but  there  is  no  penalty  for  his  failure  to  do  so,  and  the 
sperm  necessary  for  the  purpose  will  be  discharged  in 
sleep  when  it  has  accumulated  in  sufficient  quantity. 
"  Wet  dreams  "  and  involuntary  seminal  emissions  are 
not,  therefore,  necessary  evidences  of  "loss  of  man- 
hood "  or  of  any  other  disorder,  but  are  seen  to  be  the 
natural  and  healthy  method  of  disposal  of  the  sperm 
not  used  in  the  legitimate  sexual  intercourse  of  married 
life.  Every  normal  man  has  periods  of  sexual  excite- 
ment and  desire,  which  constitute  one  of  Nature's  pow- 
erful influences  in  the  perpetuation  of  the  race;  but 
self-respect  should  prompt  and  self-command  enforce  a 
determination  that  such  desire  shall  not  lead  to  acts 
that  violate  the  laws  of  religion  and  society.  These 
periods  of  excitement  and  desire  can  be  made  less  fre- 
quent, and  continence  promoted,  by  the  avoidance  of 
lasciviousness  in  speech,  conduct,  reading,  and  thoughts, 


28    THE  RECRUIT  AND  HIS  ENVIRONMENT 

by  thorough  cleanliness  and  otherwise  complete  neglect 
of  the  genitals,  and  by  a  regular,  sober,  active  life. 

The  habitual  and  excessive  use  of  alcohol  is  every- 
where conceded  to  be  harmful,  while  the  moderate  or 
judicious  use  of  it  excites  much  discussion, 
but  is,  in  this  country  at  least,  falling  into 
disfavor.  Owing  partly  to  the  prohibition  of  the  sale 
of  wines  and  beer  on  government  reservations,  the  con- 
ditions under  which  a  soldier  now  indulges  in  alcohol 
are  in  most  instances  not  conducive  to  "  moderate  "  or 
judicious  use  of  it;  so  that,  laying  aside  all  theory, 
and  dealing  only  with  the  condition  confronting  us,  it  is 
our  duty  to  advise  and  encourage  total  abstinence  in 
the  soldier.  This  we  may  be  able  to  obtain  in  certain 
instances,  but  it  does  not  seem  probable  that  it  will  be 
a  universal  characteristic  of  soldiers  during  the  active 
service  of  the  readers  of  this  paragraph.  We  should, 
however,  particularly  try  to  inculcate  it  in  the  young 
recruit,  as  the  man  who  does  not  begin  to  drink  before 
he  is  twenty-five  years  of  age  is  much  less  apt  to  become 
a  drunkard  or  a  habitual  user  than  he  who  begins  before 
he  is  twenty,  and  there  is  a  good  chance  that,  if  he 
abstains  until  that  age,  he  will  always  do  so.  On  the 
other  hand,  the  impossibility  of  knowing  who  are,  and 
who  are  not,  capable  of  using  alcohol  judiciously  should 
prevent  our  encouraging  what  we  regard  as  judicious 
use  in  soldiers.  Every  military  post  shows  in  its  guard 
reports,  its  sick  reports,  and  in  unrecorded  ways,  the 
injury  and  loss  of  service  resulting  from  excessive  use 
of  alcohol;  so  that  it  is  not  necessary  either  to  quote 
military  statistics  or  to  go  to  civil  life  for  the  lesson. 
However,  the  very  nature  of  a  soldier's  calling  so  re- 
stricts his  freedom  of  action,  so  excludes  him  from  many 


PERSONAL  HYGIENE  29 

refining  and  restraining  influences,  and  so  throws  him 
in  the  way  of  temptation  to  drink,  that  we  should  highly 
honor  him  in  the  mass  for  his  good  conduct,  and  encour- 
age him  in  it  as  an  individual. 

If  used  at  all,  alcohol  is  prefei^bly  and  least  harm- 
fully taken  with  or  after  meals. 

It  will  do  little  good  to  warn  men  against  the  use  of 
strong  alcohol,  of  flavoring  extracts,  bay  rum,  and  wood 
alcohol,  as  only  abandoned  drinkers  use  such  prepara- 
tions as  beverages,  and  such  men  are  not  apt  to  heed  the 
warning.  However,  it  is  important  to  know  that  wood 
alcohol  and  its  preparations  are  more  poisonous  than 
ordinary  alcohol,  and  that  death,  or  complete  and  per- 
manent blindness,  may  follow  their  use. 

Probably  the  least  harmful  and  the  most  general  of 
the  so-called  "bad  habits"  is  the  use  of  tobacco  in  one 
form  or  another.  In  our  army  the  methods 
of  using  it  are  smoking  and  chewing.  Of 
these  chewing  is  probably  the  most  objectionable  as 
fouling  the  mouth  and  causing  promiscuous  spitting. 
Moderate  smoking,  indulged  in  after  meals  and  in 
periods  of  i*elaxation,  cannot  be  said  to  be  very  harm- 
ful, if  at  all  so  ;  but  smoking  in  excess  may  do  harm  by 
causing  digestive,  respiratory,  and  nervous  disturbances, 
among  which  may  be  heartburn,  headache,  palpitation 
or  irregularity  of  the  heart,  insomnia,  tremor,  cough, 
and  hoarseness.  Just  what  constitutes  excess  may  not 
be  stated,  as  an  amount  harmless  to  one  man  may  be 
enough  to  cause  injury  to  another.  In  general  terms  we 
may  say  that  an  amount  causing  any  of  the  above-named 
or  other  symptoms  in  any  man  constitutes  an  excess  for 
that  man.  As  to  the  various  methods  of  smoking,  the 
same  general  principles  apply.    Cigar,  pipe,  and  cigar- 


30    THE  RECRUIT  AND  HIS  ENVIRONMENT 

ette  are  equally  harmless  if  not  used  to  excess.  The  main 
objection  to  cigar-smoking  is  the  expense ;  to  pipe- 
smoking,  the  irritation  of  the  mouth,  in  rare  instances 
eventuating  in  cancer ;  and  to  cigarette-smoking,  the 
habit  of  inhaling  the  smoke  and  thus  exposing  a  much 
greater  surface  to  the  fumes,  causing  irritation  of  the 
vocal  organs  and  the  bronchial  tubes,  and  the  habit  of 
rolling  and  smoking  a  cigarette  at  each  opportunity,  so 
that  the  total  number  consumed  becomes  excessive.  The 
habit  of  smoking  and  the  proper  indulgence  of  the  habit 
do  the  soldier  so  little  harm  and  so  greatly  increase  his 
comfort  and  contentment  that  they  should  not  be  inter- 
fered with.  Stale  tobacco-smoke  in  quarters,  however, 
gives  a  very  unpleasant  odor,  and  the  room  should  be 
daily  opened  and  aired  sufficiently  to  prevent  or  dissi- 
pate this. 

There  should  be  no  necessity  for  telling  men  to  dress 
properly  for  the  season  and  the  climate,  but  the  neces- 

_  sity  nevertheless  exists,  owing;  to  the  care- 

Temper-       1  -4.        f 

*^  lesssness,  ignorance,  or  perversity  ot  men. 

It  is  neither  profitable  nor  wise  for  an 
officer  to  undertake  to  prescribe  just  what 
his  men  shall  wear  at  all  times,  as  men 
differ  in  their  capacity  to  stand  heat  and  cold,  and  one 
man  may  be  able  to  maintain  the  highest  degree  of 
health  and  comfort  by  never  wearing  flannel  under- 
clothing, while  his  neighbor  may  promote  both  by 
wearing  it  the  year  round,  and  the  rest  of  the  men  in 
the  squad-room  by  wearing  flannel  in  winter  and  cotton 
in  summer.  But  men  should  be  taught  that  exposure 
to  either  heat  or  cold  lowers  the  resistance  of  the  body 
and  predisposes  it  to  disease  ;  that  body-warmth  is 
promoted  by  woolen  clothing  and  that  linen  and  cotton 


PERSONAL  HYGIENE  31 

make  cool  clothing ;  that  alcohol  is  not  a  fit  aubstitute 
for  an  overcoat  or  a  rain-coat ;  that  wet  feet  should  be 
dried  and  dry  coverings  substituted  for  wet  ones  after 
marching  or  other  exercise ;  that  good  intentions  or 
thoughtlessness  do  not  justify  reckless  exposure  to  ex- 
tremes; and  that  it  is  their  duty  to  the  government, 
as  well  as  to  themselves,  to  use  discretion  in  dress  and 
to  try  at  all  times  to  avoid  sickness. 

Exposure  to  strong  sunlight  is  by  some  persons  al- 
leged to  be  the  cause  of  some  of  the  evils  heretofore 
credited  to  the  heat  of  the  sun,  and  it  is  further  stated 
that  these  effects  may  be  obviated  by  tlie  use  of  hat- 
linings  and  underclothing  of  black,  red,  or  orange, 
to  exclude  the  actinic  rays.  These  statements,  how- 
ever cannot  yet  be  said  to  be  established  facts,  but 
must  await  the  results  of  further  observations  and 
experience. 

In  all  climates  and  at  all  times  the  dress  should  be 
comfortable,  and  should  hamper  the  movements,  espe- 
cially of  the  chest  and  abdomen,  as  little  as  possible. 
The  equipment  should  be  as  light  as  circumstances  will 
permit,  should  also  be  arranged  with  the  idea  of  inter- 
fering with  motion,  particularly  pf  the  chest  and  ab- 
domen, as  little  as  possible,  but  should  contain  the 
necessary  articles. 

While  the  government  supplies  the  necessities  of  the 
soldier  and  supervises  his  hygiene  to  a  considerable 
extent,  it  is  seen  already  that  the  man  himself  is  re- 
sponsible for  much,  and  there  are  a  few  more  golden 
rules  that  he  should  learn  early  for  his  own  protection, 
and  that  will  bear  frequent  emphasis  and  repetition, 
especially  in  campaign. 

1.  Be  clean  in  person,  clothing,  and  surroundings. 


32    THE   RECRUIT  AND   HIS  ENVIRONMENT 

2.  Eat  no  food  but  good  food,  and  only  with  clean 
hands. 

3.  Drink  no  water  from  unauthorized  or  doubtful 
sources,  unless  it  is  boiled, — plain,  or  in  tea  or  coffee. 

4.  Abhor,  avoid,  and  destroy  vermin,  whether  lice, 
fleas,  ticks,  flies,  mosquitoes,  roaches,  mice,  rats,  or  other 
varieties. 


CHAPTER  III 

FOODS   AND   THEIR   PREPARATION 

It  is  now  trite  and  partly  true  that  "  an  army  travels 
on  its  belly,"  and  plainly  evident  that  the  health  and 
happiness  of  the  individual  soldier  depend  very  greatly 
on  what  he  puts  into  his  belly.  This  is  a  matter  largely 
in  the  control  of  the  company  commander,  and  it  is 
therefore  important  that  he  should  have  some  know- 
ledge of  foods  and  their  preparation,  and  should  pay 
great  attention  to  mess-administration.  Many  company 
commanders  do  so,  but  others,  knowing  little  of  the 
subject,  delegate  the  entire  matter  to  their  mess-ser- 
geants, who  may  know  less,  and  the  men  suffer.  The 
government  ration  and  the  regulations  concerning  its 
use  are  very  liberal,  and  if  a  company  does  not  have 
an  abundance  of  good,  nutritious,  and  attractive  food, 
the  f aidt  is  nearly  always  in  its  handling  after  it  reaches 
the  company. 

Foods  are  of  different  classes,  and  a  judicious  and 
proper  mixture  of  these  is  necessary  for  the     classes 
maintenance  of  health  and  strength. 

Proteids,  or  albuminous  foods,  are  the  class  repre- 
sented by  the  white  of  egg  or  lean  beef.  They  occur  also 
in  vegetables,  beans  and  peas  being  particularly  ricli  in 
proteid,  and  this  fact  makes  an  exclusively  vegetarian 
diet  a  health-sustaining  possibility,  which  a  proteid  free 
diet  is  not.  Animal  proteid  is  more  easily  and  com- 
pletely digested  than  that  from  vegetables,  and  to  most 
persons  is  also  more  agreeable.  An  exclusive  meat  diet 


34    THE   RECRUIT  AND   HIS  ENVIRONMENT 

can  maintain  health  and  strength  for  long  periods  of 
time,  and  Parkman  relates  in  "  The  Oregon  Trail "  an 
experience  extending  over  several  weeks,  during  which 
he  accompanied  Indians  on  a  buffalo  hunt,  and  the 
whole  party  performed  great  amounts  of  work,  during 
almost  the  entire  time,  on  a  diet  of  buffalo  meat,  relieved 
with  a  few  berries  on  one  or  two  occasions.  Neverthe- 
less, the  tendency  in  those  accustomed  to  a  mixed  diet 
is  to  suffer  from  albuminuria  and  diarrhoea  when  using 
an  excess  of  proteids. 

Fats  are  the  class  of  food  represented  by  the  fatty 
tissues  of  animal  bodies  and  the  various  vegetable  oils. 
They  are  very  valuable  as  foods,  owing  to  their  great 
fuel-value  and  the  amount  of  nutriment  contained  in  a 
small  bulk ;  but  if  taken  in  excess  they  are  difficult  of 
digestion  and  cause  dyspepsia  and  diarrhoea.  They  are 
especially  valuable  in  cold  climates,  a  fact  which  we 
recognize  in  our  practice  of  eating  pork  and  other  fat 
foods  more  freely  in  winter. 

Carhohydrates  are  the  sugars  and  starches,  repre- 
sented by  cane-sugar,  fruit-sugar,  and  others,  and  by 
starchy  vegetables  such  as  potatoes  and  grains.  For 
practical  purposes  we  may  say  that  the  carbohydrates 
are  of  vegetable  origin.  Cellulose,  as  found  in  the  husk 
and  fibre  of  plants,  is  another  form  of  carbohydrate, 
having  a  food-value  for  herbivorous  animals  but  none 
for  man.  The  carbohydrates  have  about  the  same 
fuel-value,  weight  for  weight,  as  the  proteids,  and  less 
than  that  of  the  fats.  Starches  may  be  taken  in  large 
amounts,  but  sugar,  if  taken  in  excess  or  in  too  con- 
centrated a  form,  causes  dyspepsia  and  other  disor- 
ders. 

Inorganic  salts,  as  represented  by  common  salt  and 


FOODS   AND  THEIR  PREPARATION         35 

other  salts  contained  in  the  foods,  have  no  fuel-value, 
but  are  necessary  in  maintaining  the  nutrition  of  the 
body,  and  the  same  is  true  in  even  greater  degree  of 
water. 

Organic  acids,  flavors,  and  condiments,  as  found  in 
fruits,  many  vegetables,  and  in  spices,  are  of  value 
secondary  to  the  preceding  classes,  and  principally  for 
the  relish  they  impart. 

For  many  years  Voit's  standard  was  taken  as  repre- 
senting the  approximate   amounts  of  the  three  main 
classes  of  foods  necessary  each  twenty-four      . 
hours  for  the  maintenance  of  health  and        ,  -,      , 
vigor  in  the  average  working  adult. 

According  to  that  standard  the  requirement  was  118 
grams  of  dried  proteid,  equaling  about  one  ration  of 
beef,  56  grams  of  fat,  and  500  grams  of  carbohydrate, 
that  is,  of  starch  and  sugar.  The  total  value  of  this  diet 
was  over  3000  calories. 

Recently,  Professor  Chittenden  of  Yale  University 
has  shown  that  health,  strength,  and  vigor  can  be  main- 
tained on  half  the  amount  of  proteid,  without  any  in- 
crease in  the  fats  or  carbohydrates. 

Meats  are  mixtures  of  proteids  and  fats,  and  contain 
water  and  salts  also.    They  vary  in    palatability,  cost, 
digestibility,  and  nutritive   value ;   but  all     .-_ 
meats  have  nutritive  value,  though  if  dis- 
eased or  decomposed  they  are  not  available  for  use. 

In  our  service  heef  is  the  standard  meat  for  issue, 
mutton,  pork,  fowl,  and  fish  being,  substitutes  issued 
only  occasionally ;  and,  considering  the  cost,  nutritive 
value,  palatability,  digestibility,  tolerance,  etc.,  it  is 
the  most  valuable  meat. 

Mutton  is  almost  equally  valuable  for  nutrition,  but 


36    THE  RECRUIT  AND   HIS   ENVIRONMENT 

many  persons  dislike  the  taste  of  it,  and  almost  all  tire 
of  it  sooner  than  of  beef. 

Po7'k  is  fatter  than  either  beef  or  mutton,  and  is 
therefore  much  more  used  in  cold  than  in  warm  weather. 
It  is  more  difficult  of  digestion  than  beef  and  not  so 
generally  liked,  though  bacon  is  much  used  in  the  army 
and  is  a  popular  and  valuable  food,  especially  in  the 
field. 

Veal  is  seldom  issued  to  troops.  Its  nutritive  value 
is  somewhat  less  than  that  of  beef,  and  it  causes  diar- 
rhoea in  some  persons. 

Fowl^  as  chicken  or  turkey,  constitutes  a  special 
treat  on  national  holidays  and  festal  occasions.  If 
freshly  killed  and  healthy  fowls  are  served,  it  is  valu- 
able as  well  as  appetizing  food ;  but  when  birds  long 
kept  undrawn  in  cold  storage  are  issued,  as  is  not  in- 
frequently the  case,  their  quality  should  be  suspected 
and  each  bird  carefully  scrutinized,  and,  if  of  doubtful 
appearance  or  odor,  rejected. 

Fish  vary  greatly  in  palatability  and  nutritive  value, 
but  all  of  them  keep  poorly,  especially  if  allowed  to  die 
slowly  and  if  not  packed  in  ice  or  frozen.  The  meat 
should  feel  firm  to  the  touch,  and  not  crush  on  gentle 
pressure.  Dried  and  canned  fish,  as  issued,  are  practi- 
cally always  good,  but  they  are  not  suitable  for  fre- 
quent or  prolonged  use,  as  men  very  soon  tire  of  them. 

Fggs  consist  of  animal  proteid  and  fat,  and  are 
classed  with  the  meats.  They  are  nutritious  and  usually 
easy  of  digestion.  They  may  be  cooked  in  a  great  va- 
riety of  ways  as  a  main  dish,  and  are  very  frequently 
used  in  other  dishes,  such  as  puddings  and  cakes. 

All  meats  should  be  eaten  cooked,  as  proper  cooking 
improves  the  flavor,  increases  digestibility,  and  destroys 


FOODS  AND  THEIR  PREPARATION         37 

parasites  that  might  otherwise  cause  disease  in  the 
eater.  Among  the  disease-producing  organisms  which 
may  be  conveyed  by  meats  but  which  can  be  destroyed 
by  heat  are  :  — 

1.  Tapeworms  of  various  kinds,  the  three  most  com- 
mon ones  being  transmitted  respectively  by  beef,  pork, 
and  fish,  the  meat  in  either  case  being  "  measly." 

2.  Trichina,  a  species  of  larval  worm  which  infests 
the  muscles,  causing  great  suffering,  and,  at  times, 
death.  It  is  conveyed  to  man  by  eating  underdone 
pork. 

3.  Tubercle  bacilli,  the  cause  of  tuberculosis  or  con- 
sumption. 

4.  Bacteria  causing  some  animal  diseases,  which 
may  reproduce  the  same  diseases  in  man,  or  may 
merely  cause  intestinal  trouble.  Paratyphoid,  a  disease 
resembling  typhoid,  may  be  so  produced. 

5.  Hay  fungus,  the  cause  of  actinomycosis  or  lumpy 
jaw  in  cattle. 

6.  Typhoid  bacillus,  the  cause  of  typhoid  fever,  may 
be  conveyed  in  oysters  or  other  shellfish  coming  from 
polluted  waters. 

7.  The  bacillus  of  anthrax,  the  cause  of  a  very  fatal 
disease. 

8.  The  bacillus  causing  "  trembles "  in  cattle  and 
'•'"milk  sickness^''  in  man. 

Some  diseases  fatal  to  food  animals  do  not  affect  man, 
and  the  flesh  of  animals  dead  of  such  diseases  can  safely 
be  eaten ;  but  in  general  it  is  safe  and  wise  to  avoid  all 
such  meat,  as,  though  the  disease  killing  the  animal  may 
not  affect  man,  chemical  changes  may  have  occurred  in 
it  to  give  rise  to  poisons,  and  ptomaine  poisoning  or 
"meat  poisoning"  may  result.  Ptomaine  poisoning  ToaLj 


38    THE  RECRUIT  AND  HIS  ENVIRONMENT 

also  result  from  the  action  of  bacteria  contaminating 
the  meat  after  death,  or  even  after  cooking,  and  causing 
changes  in  it.  Such  instances  are  seen  when  poisoning 
occurs  from  cold  meat  or  hash  cooked  some  days  before 
use,  or  from  canned  meat  taken  from  imperfect  tins. 
When  the  ptomaine  or  other  poisonous  products  of 
bacterial  action  are  once  formed  in  the  meat,  they  often 
may  not  be  destroyed  by  cooking,  and  all  such  meats 
are  dangerous. 

Some  few  kinds  of  meat,  principally  fish,  are  poison- 
ous in  themselves. 

Meats  are  preserved  for  use  in  a  variety  of  ways,  only 
a  small  percentage  of  those  furnished  the  army  being 
used  so  soon  after  killing  as  not  to  require  some  form 
of  artificial  preservation.  Of  these  methods  of  preserv- 
ing, cold  is  the  most  satisfactory  and  best  keeps  the 
meat  unchanged,  and  by  this  means  it  may  be  kept  for 
months.  It  is  applied  so  as  to  freeze  or  merely  to  "  chill " 
the  meat,  and  its  only  effects  are  to  render  the  flesh 
more  tender  and  to  detract  somewhat  from  its  flavor. 
Frozen  meat  may  be  kept  indefinitely,  but  that  which  is 
merely  chilled  does  deteriorate  in  time,  becoming  soft, 
slippery,  and  flavorless.  It  should  not  then  be  used  as 
food. 

Cold  cannot  be  depended  upon  to  destroy  the  germs 
or  parasites  in  meat,  though  keeping  for  a  long  time 
will  destroy  some  of  them.  Salting,  pickling,  and  smoh- 
ing  are  much  used  in  preserving  meats,  particularly  beef 
and  pork,  and  the  results  are  very  good.  Ham,  bacon, 
and  corned  or  smoked  beef  are  excellent  and  palatable 
meats  for  occasional  use,  but  they  are  not  adapted  to 
long  use  to  the  exclusion  of  fresh  meats,  and  when  they 
are  so  used  the  health  is  apt  to  suffer.  These  processes 


FOODS  AND  THEIR  PREPARATION    39 

tend  to  free  the  meats  from  parasites,  but  cannot  be 
depended  upon  to  do  so,  and  the  eating  of  raw  ham  is  a 
dangerous  procedure.  Canning,  with  its  attendant  ster- 
ilization of  the  meat,  preserves  all  of  its  nutriment  and 
destroys  all  parasites,  but  it  melts  the  fat,  gelatinizes 
the  gristle,  and  softens  the  muscle,  so  that  the  meat 
comes  from  the  can  less  attractive  to  the  eye  or  the 
palate,  but  otherwise  good  and  valuable. 

Preservation  by  means  of  drugs  and  chemicals,  other 
than  those  used  in  pickling  or  salting,  such  as  boric  acid 
or  formalin,  is  forbidden,  and  meat  so  preserved  may 
cause  sickness  ;  but  for  emergencies  and  occasional  use 
it  would  not  ordinarily  do  so. 

It  is  not  desirable  here  to  consider  in  detail  the  vari- 
ous methods  of  cooking  meats,  but  the  company  officer 
should  exercise  a  certain  amount  of  supervision  in  the 
matter,  to  see  that  his  men's  digestion  is  not  injured 
by  an  excessive  use  of  fried  meats,  that  their  appetites 
are  not  impaired  by  poorly  prepared  or  poorly  served 
roasts,  stews,  and  hashes.  A  company  mess  is  often  good 
or  bad  as  the  cook  knows,  or  does  not  know,  how  to 
handle,  prepare,  utilize,  and  serve  meats.  Rather  com- 
mon faults  in  company  cooks  are  as  follows :  — 

Roast  or  baked  meat  is  overcooked  and  dry,  is  taken 
from  the  oven  an  hour  or  two  hours  before  meal-time 
and  sliced,  and  is  served  with  hot,  greasy  gravy  to  make 
it  warm. 

Tough  ends,  scraps,  and  l)ones  are  not  utilized  in 
making  soup  stock,  as  they  should  be. 

Excessive  fat  is  not  rendered  and  utilized. 

Hashes  and  stews  are  served  with  unnecessary  fre- 
quency, and  become  monotonous. 

Lack  of  imagination  or  lack  of  knowledge  on  the 


40    THE  RECRUIT  AND  HIS  ENVIRONMENT 

part  of  the  cook  and  mess-sergeant  result  in  lack  of 
variety  and  attractiveness  of  the  mess.  Intelligent 
supervision  of  the  mess  by  the  company  commander, 
the  preparation  of  bills  of  fare  in  advance,  so  as  to  in- 
sure variety,  and  the  study  of  good  cook-books  will 
obviate  this. 

The  principal  carbohydrate  food  is  bread,  and  its 
importance  in  the  mess  is  scarcely,  if  at  all,  secondary 
to  that  of  meat.  The  ordinary  supply  of 
bread  is  issued  as  such,  and  its  quality 
depends  largely  on  the  capacity  of  the  post  baker, 
notwithstanding  his  proneness  to  credit  any  defects 
in  it  to  the  flour,  the  yeast,  the  hops,  or  the  oven.  The 
materials  supplied  by  the  government  are,  with  rare 
exceptions,  excellent,  and  the  failure  to  produce  good 
bread  is  usually  to  be  attributed  to  either  the  ignorance, 
the  carelessness,  or  the  uncleanliness  of  the  baker. 
With  the  proper  training  of  the  bakers  such  failures 
will  seldom  be  seen.  Company  cooks  are  permitted, 
and  should  be  encouraged,  to  bake  biscuit  and  muffins 
occasionally.  They  are  somewhat  more  difficult  of 
digestion  than  good  issue  bread,  but  are  much  liked 
and  add  to  the  attractiveness  of  the  mess.  Stale  bread 
(that  is,  more  than  twenty-four  hours  old)  is  somewhat 
more  digestible  than  fresh  or  hot  bread  ;  but  during 
the  process  of  staling  it  should  be  kept  covered  and 
protected  from  dust,  and  should  not  be  unnecessarily 
handled,  nor  by  any  but  clean  hands ;  otherwise  bac- 
teria and  moulds  finds  lodgment  and  growth  upon  it 
and  may  produce  disease.  Toasting  improves  some 
breads  and  adds  to  their  digestibility,  but  it  is  not 
often  done  in  companies. 

Pastries  and  cake  are  also  bread,  but  are  less  easily 


FOODS  AND  THEIR  PREPARATION         41 

digestible  than  the  ordinary  forms.  They  add  much  to 
the  attractiveness  of  a  mess  and  should  be  sei-ved  occa- 
sionally. The  same  remarks  apply  to  the  various  kinds 
of  batter-cakes. 

Cornhread  also  makes  a  pleasant  change  from  the 
monotony  of  baker's  bread,  and,  as  it  is  cheap,  palat- 
able, and  nourishing,  its  use  is  to  be  encouraged. 

Corn-meal  mush,  with  butter  or  milk,  is  also  relished, 
and  when  cold  may  be  sliced  and  fried. 

Hard  bread  is  issued  only  for  field  use.  Good  teeth 
are  necessary  for  its  utilization  as  issued,  but  it  may 
be  softened  in  hot  water  or  coffee  without  impairing 
its  value. 

A  measure  of  economy,  sometimes  ignored,  is  the 
utilization  of  crusts  and  fragments  of  stale  bread  in 
puddings,  as  meat-stuffing,  and  in  other  ways.  Such 
practices  add  to  the  variety  and  attractiveness  of  the 
mess,  and  allow  savings  to  be  made  in  other  direc- 
tions. To  thi'ow  away  such  crusts  because  sugar  and 
eggs  are  necessary  in  puddings  and  cost  a  little  extra, 
is  wasteful  and  wrong. 

Vegetables  supply  all  classes  of  foods,  and  are  very 
important  in  the  soldier's  mess    for  this  reason,  and 
because  they  serve  to  impart  variety  and     _- 
attractiveness   to  it.   The  most  important         ^^ 
vegetable  issued  (except  wheat)  is  the  j^o- 
tato,  which  consists  of   almost  pure  starch.  It  may  be 
cooked  in  a  much  greater  variety  of  ways  than  is  usual 
in  most  companies,  and  the  company  commander  should 
see  that  such  is  the  case.  In  whatever  way  they  are  pre- 
pared, potatoes  should  be  cooked  until  soft  or  mealy, 
and  should  be  served  hot. 

nice  is  another  valuable  starchy  food,  and  in  some 


42    THE  RECRUIT  AND  HIS  ENVIRONMENT 

parts  of  the  world  it  is  the  main  article  of  diet;  but  in 
our  country  it  is  much  less  used  and  less  desired  than 
bread  or  potatoes.  It  is  most  popular  with  soldiers  as 
a  pudding,  though  it  may  be  prepared  in  a  variety  of 
ways.  It  should  be  used  to  give  variety  and  served  in 
attractive  forms,  cooked  with  tomatoes  or  something 
else  to  take  away  its  insipidity. 

Co7'n  is  also  to  be  classed  as  a  starchy  food.  In  ad- 
dition to  the  uses  discussed,  it  may  be  eaten  in  the 
whole  grain,  in  its  green,  canned,  or  ripe,  dry  state. 
Green  or  canned  corn  is  not  so  nutritious  as  the  ripe, 
but  it  is  much  liked  and  should  be  used  for  the  sake 
of  variety.  Ripe  corn  in  the  whole  or  the  broken 
grain,  as  hominy  or  grits,  is  not  so  generally  liked  as 
the  green,  but  it  is  very  nutritious,  and  should  be  used 
occasionally  as  a  principal  dish. 

Macaroni  and  other  paste  preparations  are  valuable 
foods,  and  admit  of  a  variety  of  presentations,  so  that 
their  use  should  be  encouraged. 

Onions  are  a  staple  article  of  issue,  and  are  much 
used  in  the  army.  Their  nutritive  value  is  much  less 
than  that  of  the  articles  just  discussed,  but  their  flavor 
and  the  variety  of  ways  in  which  they  may  be  used 
make  them  very  valuable.  Monotony  should  be  avoided 
in  their  use. 

Tomatoes^  likewise,  have  relatively  little  food-value, 
but  stand  high  for  their  flavor  and  the  variety  they 
afford.  When  they  are  served  cooked,  it  should  often 
be  with  some  otherwise  insipid  food,  such  as  rice,  maca- 
roni, or  stale  bread. 

Beans  andpeors,  though  possessing  considerable  starch, 
are  the  principal  sources  of  vegetable  proteid.  They 
are  both  very  attractive  and  palatable  in  the  green  state, 


FOODS  AND  THEIR  PREPARATION         43 

and,  though  less  nutritive  than  when  ripe,  add  much  to 
the  mess.  When  dried,  they  are  particularly  valuable 
in  making  soup  (for  use  in  which  ham-bones  and  rinds 
should  always  be  saved),  and  when  served  boiled  or 
baked,  with  bacon.  They  are,  however,  somewhat  diffi- 
cult of  digestion,  and  their  cheapness  should  not  lead 
to  too  frequent  use. 

Beets  are  another  valuable  source  of  food,  as  they 
contain  much  sugar.  They  are  also  cheap,  and  are 
relished  by  most  men. 

Most  of  the  common  vegetables,  as  cabbage,  greens, 
carrots,  spinach,  radishes,  and  cucumbers,  have  little 
nutritive  value,  but  they  add  greatly  to  the  attractive- 
ness of  the  mess  and  are  also  valuable  in  preserving 
health  and  preventing  scurvy,  and  their  use  should  be 
encouraged. 

Salads  are  not  used  in  company  messes  as  much  as 
they  should  be.  They  afford  pleasing  variety,  and  may 
be  made  to  constitute  an  important  dish,  as     «   ,    , 
when  composed  principally  of  potatoes  or 
salmon. 

As  issued  in  company  messes,  desserts  are  nearly  al- 
ways very  simple,  and  such  is  necessarily  the  case. 
When  practicable,  a  dessert  should  be  fur-  ^ 
nished  once  a  day,  and  it  may  be  made  to 
use  up  otherwise  unattractive  articles,  such  as  rice  or 
stale  bread  made  into  puddings.  Pies  made  of  fresh 
or  dried  fruits  are  easy  to  make  and  serve,  are  inex- 
pensive, and  well  liked. 

Milk  and  its  products  constitute  important  articles  of 
food,  though  not  entering  so  largely  into     --..,, 
the  soldier's  dietary  as  they  might.  Milk 
contains  all  classes  of  food,  —  proteid,  fat,  carbohydrate, 


44    THE   RECRUIT  AND  HIS  ENVIRONMENT 

water,  and  salts,  —  though  not  in  the  proportions  desir- 
able in  maintaining  adult  life.  Fresh  milk  is  both  more 
palatable  and  more  wholesome  than  the  canned  or  con- 
densed article,  if  its  purity  and  freedom  from  disease- 
producing  germs  can  be  assured,  but  unfortunately  this 
is  not  always  the  case.  It  should  be  borne  in  mind  that 
many  serious  diseases  may  be  conveyed  in  milk,  among 
them  tuberculosis,  typhoid  fever,  diphtheria,  and  scarlet 
fever,  —  some  of  the  diseases  most  dreaded  in  military 
life.  Milk  sickness,  a  disease  now  rarely  seen,  was  also 
conveyed  in  that  way ;  while  for  many  years  the  Med- 
iterranean garrisons  of  the  British  army  suffered  very 
seriously  from  Malta  fever,  now  known  to  have  been 
transmitted  by  means  of  goats'  milk. 

In  case  of  epidemic  of  any  of  the  above-named 
diseases,  the  milk  supply  should  be  investigated,  and 
this  is  particularly  suggested  by  outbreaks  of  typhoid 
showing  an  explosive  character,  that  is,  epidemics  in 
which  many  cases  occur  almost  simultaneously.  Because 
of  this  possibility  of  disease-production,  milk  whose 
origin  and  condition  are  not  above  reproach  should  be 
used  in  companies  and  post  exchanges  only  in  cooking 
or  after  boiling,  and  in  camp  or  on  the  march  men 
should  be  cautioned  to  the  same  effect,  and  warned 
against  purchasing  it  by  the  glass  from  dealers  or  ped- 
dlers. Condensed  or  evaporated  milk  is  more  gener- 
ally used  in  companies  than  the  fresh  article,  and  it  is 
on  the  whole  probably  safer,  as  the  process  of  conden- 
sation and  the  subsequent  prolonged  storage  tend  to 
destroy  disease-producing  organisms.  A  can  of  such 
milk,  when  once  opened,  should  either  be  used  promptly 
or  kept  cool  and  protected  from  dust  until  used.  Boil- 
ing water  should  be  used  to  dilute  it,  to  kill  germs 


FOODS  AND  THEIR   PREPARATION        45 

that  may  have  settled  and  grown  on  it  after  the  open- 
ing of  the  can. 

Buttermilk  is  a  valuable  and  pleasant  drink,  and 
where  it  can  be  obtained  is  much  relished  by  the  men. 

Good  hutter  is  made  from  good  cream  and  is  every- 
where highly  appreciated ;  but  unfortunately  the  good 
quality  is  not  always  obtainable,  and  much  very  poor 
butter  is  used  in  company  messes.  Oleomargarine  is 
little  inferior  to  butter  in  nutritive  qualities  and  is  to  be 
preferred  to  poor  butter,  except  that  a  prejudice  exists 
against  it  in  this  country  and  men  are  apt  to  avoid  its 
use.  It  has  an  advantage  over  butter  in  that  it  is  not 
so  likely  to  act  as  a  carrier  of  disease  germs,  notably 
tuberculosis. 

Both  are  valuable  fat  foods  as  well  as  relishes,  and 
should  not  be  regarded  merely  in  the  latter  light. 

Cheeses  are  very  concentrated  forms  of  food,  con- 
taining about  one  third  proteid  and  one  third  fat, 
though  the  different  varieties  differ  in  the  percentages 
of  these.  They  make  agreeable  and  valuable  additions 
to  the  mess,  but  are  seldom  used  in  large  quantities 
because  they  are  apt  to  be  difficult  to  digest,  and  to 
cause  constipation.  Ordinarily  they  are  used  in  compa- 
nies rather  as  a  condiment  than  for  their  food-values, 
though  at  times  they  may  constitute  an  important  part 
of  a  meal.  In  cooking,  cheese  is  used  principally  with 
macaroni.  Milk  and  cheese  are  liable  to  certain  changes 
which  cause  the  development  of  poisons,  one  of  these, 
known  as  tyrotoxicon,  being  very  powerful  and  produc- 
ing severe  symptoms  or  death.  The  ordinary  souring  of 
milk  is  not  in  itself  dangerous,  but  may  be  beneficial 
in  some  respects.  The  justification  for  regarding  sour 
milk  with  suspicion  lies  in  the  fact  that  the  conditions 


46    THE  RECRUIT  AND  HIS  ENVIRONMENT 

favoring  the  development  of  the  bacteria  causing  the 
souring  may  also  have  favored  the  development  of  dis- 
ease-producing organisms.  Milk  should  be  preserved 
either  by  refrigeration,  to  prevent  the  growth,  or  by 
heating,  to  kill,  the  contained  bacteria. 

For  preserving  other  foods  than  meats  and  milk, 
refrigeration,  canning,  and  drying  are  the  three  great 
commercial  methods.  Cold  storage  may  pre- 
serve  fruits  and  vegetables,  as  well  as  meats, 
eggs,  and  milk,  practically  unchanged  for 
weeks,  and  immense  quantities  are  so  preserved  and 
sold.  Of  even  greater  importance,  however,  is  the  pro- 
cess of  canning,  whereby  the  articles  are  cooked,  ster- 
ilized, and  hermetically  sealed  in  cans  or  jars,  to  be 
preserved  for  months  or  years.  This  industry  has  in- 
creased enormously,  and  is  now  applied  to  almost  all 
of  the  articles  of  food  that  have  been  discussed  herein, 
and  to  a  great  number  of  others  not  so  discussed. 

The  results  obtained  are  excellent,  and  such  foods 
are  carried  to  all  parts  of  the  world  and  enjoyed. 

Canned  foods  pall  after  a  time,  though,  and  should 
never,  if  it  can  be  avoided,  be  used  to  the  exclusion  of 
fresh  food.  Otherwise  nutrition  may  be  impaired,  and 
even  scurvy  may  result.  This  may  be  because  the  heat 
necessary  to  preserve  them  destroys  some  content  that 
is  thus  far  intangible.  The  fear  of  metallic  poisoning 
from  canned  foods  is  thought  to  be  exaggerated,  and  the 
probability  of  such  poisoning  to  be  remote,  except  where 
lead  is  used,  and  that  is  infrequent  and  does  not  apply 
to  the  great  bulk  of  canned  foods  used  by  the  soldier. 

Drying  as  a  method  of  preservation  is  applied  to 
fruits  and  vegetables,  as  well  as  to  meats  and  fish. 
Desiccated  vegetables  find  some  use  in  the  army,  par- 


FOODS  AND  THEIR  PREPARATION         47 

ticularly  in  Alaska,  where  they  constitute  a  real  bless- 
ing, but  their  use  is  not  general. 

Dried  fruits,  however,  are  everywhere  used  and  with 
very  general  satisfaction.  Dried  apples,  peaches,  prunes, 
and  raisins  are  issued  or  sold  by  the  Subsistence  De- 
partment, and  make  valuable  and  pleasing  additions  to 
the  mess,  where  they  are  served  stewed  or  in  puddings 
and  other  desserts. 

Sweets  are  much  enjoyed  by  the  men,  and  are  valu- 
able for  their  fuel- value,  and  also,  probably,  as  lessen- 
ing a  craving  for  alcohol.  Syrup  and  jam  „  o^t^ 
are  articles  of  the  ration  that  are  much  en- 
joyed, while  the  sale  of  candy  by  the  Subsidence  De- 
partment shows  that  its  worth  is  recognized.  As  stated 
before,  an  excess  of  sugar  causes  dyspepsia  and  should 
be  guarded  against. 

Coffee,  tea,  and  cocoa  are  mild  stimulants,  but  may 
almost  as  well  be  classed  with  condiments.  Of  the  three, 
coffee  is  the  only  one  extensively  used  in     „ 
our  service,  and  it  is  often  poorly  made  and 
poorly  served.     The   green  issue  coffee  is 
of  excellent  grade,  and  if  properly  roasted  and  ground, 
aud  used  fresh,  is  superior  to  most  higher  priced  coffees 
obtained  elsewhere,  ready  roasted.    The  preparation  of 
good  coffee  is  simple  and  easy,  but  most  company  cooks 
do  not  practice  it.    The  company  commanders  should 
make  sure  that,  in  addition  to  proper  steps  in  prepara- 
tion, the  following  are  observed  :  — 

The  coffee  must  not  be  long  boiled. 

The  coffee-pot  must  be  emptied  and  cleaned  after 
each  meal,  and  no  coffee  grounds  should  be  used  twice. 

The  sugar  and  milk,  if  the  latter  be  served,  should 
be  put  in  by  the  user  and  not  served  alike  to  all. 


48    THE  RECRUIT  AND  HIS  ENVIRONMENT 

Enough  coffee  should  be  used  to  give  strength  and 
flavor  to  the  beverage,  and  then  but  a  moderate  amount 
of  it  should  be  served  to  each  man. 

In  the  field,  where  the  water  is  of  a  doubtful  char- 
acter, the  issue  of  large  amounts  of  weak  coffee  is  justi- 
fied, as  tending  to  reduce  the  amount  of  unboiled  water 
used ;  but  in  posts  this  is  not  necessary. 

Cooks  will  insist  that  the  men  prefer  their  coffee 
weak,  long-boiled,  and  ready  sweetened,  just  as  they 
will  say  that  they  prefer  roast  beef  overcooked,  dry,  and 
swimming  in  greasy  gravy  ;  but  inasmuch  as  most  men 
in  civil  life  like  to  exercise  a  choice  in  such  matters,  it 
is  thought  that  a  like  privilege  might  be  appreciated  in 
the  service. 

It  is  also  thought  that  perhaps  the  use  of  tea  in  the 
service  might  become  more  general  if  the  beverage  were 
properly  made,  and  not  boiled  or  steeped  until  a  strong, 
black  tannin  solution  results. 

The  following  is  a  bill  of  fare  for  one  week,  which, 
it  has  been  demonstrated,  can  be  supplied  with  little 
extra  cost  beyond  the  savings  on  the  ration,  provided 
that  the  cook  is  capable  and  careful  and  the  mess-ser- 
geant intelligent.  Slight  variations  from  week  to  week 
and  to  suit  the  seasons  will  permit  such  a  bill  of  fare 
to  be  used  for  a  long  period  and  give  satisfaction. 

MONDAY 

Breakfast :  Stewed  Fruit,  Fried  Eggs,  Bacon,  Bread, 
and  Coffee. 

Dinner :  Roast  Beef,  Steak,  or  Meat  Balls ;  Baked 
Potatoes,  Squash  or  Turnips,  Stewed  Tomatoes  ;  Pie  or 
Cake. 


FOODS  AND  THEIR   PREPARATION        49 

Supper :  Cold  Sliced  Beef,  Fried  Onions  or  Toma- 
toes, Bread  and  Jam,  Tea  or  Coffee. 


TUESDAY 

Breakfast :  Bananas  or  Fresh  Fruit,  Liver  or  Kid- 
ney with  Bacon,  Bread,  Butter,  and  Coffee. 

Dinner :  Beef  Steak  or  Hamburger  Steak ;  Potatoes, 
Eadishes,  or  Onions  ;  Pudding,  Bread,  and  Coffee. 

Supper'.  Cold  Beef,  Fried  Potatoes,  Bread  and  Jam, 
Tea  or  Coffee. 

WEDNESDAY 

Breakfast :  Stewed  Fruit,  Fried  Mush  and  Molasses, 
Coffee. 

Dinner:  Boiled  Ham;  Boiled  Potatoes,  Boiled  Cab- 
bage; Pudding,  Bread,  and  Coffee. 

Supper :  Cold  Boiled  Ham,  Bread  and  Jam,  Butter, 
Tea  or  Coffee. 

THURSDAY 

Breakfast :  Stewed  Fruit,  Puffed  Rice,  Wet  Hash 
on  Toast. 

Dinner :  Roast  Beef,  Steak,  or  Meat  Balls  ;  Baked 
Potatoes,  Corn,  Squash,  or  Turnips  ;  Pudding,  Bread, 
and  Coffee. 

Supper :  Cold  Beef  or  Hash,  Bread  and  Jam,  Fried 
Onions  or  Tomatoes,  Tea  or  Coffee. 

FRIDAY 

Breakfast :  Stewed  Fruit,  Oatmeal  with  Milk,  Bis- 
cuits with  Syrup  and  Coffee. 

Dinner :  Baked  Fish  with  Sauce ;  Boiled  Potatoes 
and  Onions ;  Bread,  Butter,  and  Coffee. 


50    THE   RECRUIT  AND  HIS  ENVIRONMENT 

Supper :  Salmon  or  other  Fish  Salad,  Bread  and  Jam, 
Tea  or  Coffee. 

SATURDAY 

Breakfast :  Stewed  Fruit,  Bacon,  Rice  or  Corn  Flakes, 
Toast,  and  Coffee. 

Dinner :  Baked  Beans  with  Pork ;  Pickles,  Stewed 
Tomatoes  ;  Bread  and  Coffee. 

Suj)per :  Cold  Beans  or  Bean  Soup,  Pickles,  Tomato 
Catsup,  Bread,  Butter,  and  Coffee. 

SUNDAY 

Breakfast :  Stewed  Fruit,  Oatmeal  with  Milk,  Hot 
Biscuits,  Coffee. 

Dinner :  Roast  Pork,  Veal,  or  Mutton ;  Browned  Po- 
tatoes, Baked  Squash ;  Apple  Sauce,  Pie  or  Cake. 

Supper :  Cold  Meat,  Bread  and  Jam,  Tea  or  Coffee. 

The  Hygiene  of  the  Kitchen 

From  the  hygienic  and  many  other  points  of  view  the 
company  kitchen  is  one  of  the  most  important  places 
in  the  post,  and  the  company  cook  a  very  important 
person. 

These  two  bear  a  more  direct  relation  to  the  guard 
reports,  sick  reports,  and  the  general  efficiency  of  the 
command  than  at  first  appears ;  while  the  subjects  of 
alcoholism  and  desertion  are  especially  involved. 

It  is  therefore  an  important  part  of  the  company  com- 
mander's duties  to  see  that  both  are  as  good  as  can  be 
obtained.  He  should  see,  as  stated  before,  that  his  cook 
is  capable  of  preparing  the  food  in  attractive,  satisfy- 
ing, and  digestible  forms,  that  he  is  economical,  a  good 
manager,  and  can  utilize  the  ration  in  a  variety  of  ways 
and  supplement  it  judiciously.  But  the  cook  may  fulfill 


FOODS  AND   THEIR  PREPARATION        51 

these  requirements  and  still  do  much  harm  by  causing 
or  spreading  disease.  Therefore  he  and  his  company 
officers  should  know  something  of  the  hygiene  of  the 
kitchen. 

The  primary  and  most  important  rule  as  to  cook, 
kitchen,  and  the  contents  and  surroundings  of  the  latter, 
is  cleanliness.  All  parts  of  the  barracks  and 
all  persons  therein  should  be  clean,  but  the 
kitchen  and  the  cook  should  excel.  The  cook  should 
bathe  often,  change  his  clothing  frequently,  always 
wash  his  hands  after  a  visit  to  the  toilet,  after  handling 
anything  dirty,  and  before  handling  foods.  He  should 
always  have  a  clean  hand-towel  in  his  kitchen,  and  not 
use  for  the  purpose  either  a  dirty  rag  or  his  dish-towels. 
He  should  wear  white  aprons,  caps,  and  clothing,  and 
change  them  when  soiled.  His  finger-nails  and  his  hair 
should  be  kept  short  and  clean,  and  a  nail-brush  should 
be  in  the  kitchen  for  use  and  should  be  scalded  daily. 
A  cook  who  has  had  typhoid  fever,  or,  rarely,  one  who 
does  not  know  that  he  has  had  it,  may,  though  appar- 
ently in  good  health,  be  excreting  and  distributing 
typhoid  bacilli ;  and  a  typhoid  epidemic  limited  to  a 
company  should  always  cause  this  possibility  to  be 
investigated.  Men  who  are  dirty  in  their  habits,  who 
have  syphilis,  tuberculosis,  or  other  infectious  dis- 
eases, or  who  are  persistent  in  unsanitary  or  careless 
methods  of  preparing  foods,  should  not  be  allowed  to 
cook. 

The  kitchen  should  be  proof  against  the  most  rigid 
inspection  for  dirt.  Some  disorder  and  litter  necessarily 
attend  the  preparation  of  food  ;  but  this  can  usually  be 
cleared  up  almost  immediately,  and  it  should  not  remain 
any  longer  than   necessary.    The  meat-block,  bread- 


52    THE   RECRUIT  AND  HIS  ENVIRONMENT 

boards,  carving-tables,  and  all  utensils  should  all  be  in- 
spected daily  and  all  kept  clean. 

The  ice-chest  and  milk-cans  should  receive  special 
scrutiny,  and  should  be  clean  inside  and  out,  as  evi- 
denced to  the  eye,  the  nose,  and  the  white  glove. 

Foods  like  cheese,  codfish,  and  bacon,  that  possess  a 
strong  odor  and  do  not  readily  spoil,  should  be  kept  on 
shelves  or  in  boxes,  protected  by  wire  gauze,  rather  than 
in  the  ice-chest.  Canned  meats,  fruit,  and  vegetables 
should  be  used  as  soon  as  possible  after  they  are  opened, 
or  emptied  into  clean  dishes,  and  not  left  about  in  the 
cans.  All  food  should  be  used  before  it  becomes  mouldy, 
sour,  or  decomposed,  or  should  be  thrown  away,  though 
a  slight  and  recent  growth  of  mould  on  the  surface  of 
ham,  cold-storage  beef,  bread,  jam  or  other  sweets 
does  not  necessarily  injure  the  whole,  and  may  be  re- 
moved. 

The  kitchen  sinks  should  always  be  kept  clean,  and 
should  be  well  trapped.  Care  should  be  exercised  that 
grease,  crumbs,  and  fragments  are  kept  out  of  them, 
that  the  pipes  may  not  become  clogged.  Kitchen  waste, 
the  scrapings  of  food  from  plates,  and  unused  frag- 
ments should  be  thrown  into  covered  cans,  which  should 
be  emptied  and  cleaned  once  daily,  and  should  not  serve 
either  as  a  breeding  or  a  feeding  place  for  flies,  roaches, 
rats,  or  other  vermin.  Particular  care  should  be  exer- 
cised to  exclude  all  such  from  the  kitchen  at  all  times. 
For  this  purpose  cleanliness  and  screens  should  suffice, 
but  if  fly-paper,  roach-poison,  and  rat-traps  are  needed, 
they  should  be  supplied. 

The  kitchen  police  is  usually  supplied  by  roster  from 
the  company,  but  at  times  the  work  is  given  as  a  pun- 
ishment.   This  is  undesirable.  Instead  of   poor  men, 


FOODS  AND  THEIR  PREPARATION         53 

good  ones  should  be  put  on  kitchen  police,  and  the  work 
should  carry  with  it  immunities  and  privileges  to  make 
good  men  desire  it.* 

^  For  fuller  and  more  comprehensive  information  on  the  preparation 
of  foods  and  mess-management,  the  reader  is  referred  to  the  book 
entitled  Handling  the  Straight  Army  Ration  and  Baking  Bread,  by 
Captain  T.  R.  Holbrook  and  Color-Sergeant  Patrick  Dunne,  5th  U.  S. 
Cavalry,  and  to  the  course  of  instruction  given  at  the  Army  Training 
School  for  Bakers  and  Cooks  at  Fort  Riley,  Kansas,  both  of  which  are 
highly  commended.  No  opportunity  to  have  a  cook  trained  in  the  school 
should  be  neglected.  The  Army  Cook  Book  and  the  Subsistence  Man- 
ual are  also  very  important  sources  of  information  on  this  subject. 


CHAPTER  IV 

THE   HYGIENE   OF   THE   BAKRACK8 

Neither  the  enlisted  man  nor  his  immediate  com- 
mander has  very  much  choice  in  the  matter  of  bar- 
racks. They  are  assigned  to  duty  at  a  post  where 
certain  barracks  are  provided,  and  must  of  necessity 
make  use  of  them.  In  one  post  the  barracks  may  be 
new,  large,  and  built  with  a  view  of  affording  all  pos- 
sible advantages  in  the  way  of  comfort,  convenience, 
and  sanitary  arrangements.  In  another  post  they  may 
be  old,  small,  and  apparently  built  without  a  thought 
of  any  of  the  advantages  mentioned.  In  the  one  the 
capacity  of  the  barracks  may  greatly  exceed  the  size 
of  the  garrison,  in  the  other,  the  reverse  may  obtain ; 
but  in  nearly  all  instances  the  conditions  are  controlled 
by  military  necessity  and  not  by  the  company  com- 
manders. It  is  therefore  considered  that  the  proper 
scope  of  this  chapter  is  to  indicate  what  is  desirable, 
and  to  assist  in  making  the  nearest  practicable  ap- 
proach to  it  under  existing  conditions. 

The  buildings  are  apt  to  be  of  almost  any  material, 

from  brick,   stone,   or  concrete,  to  nipa  and  thatch. 

Usually  they  are  of  substantial  materials 

.  ^^     '  and  well  constructed,  unless  designed  for 

insis  .  . 

merely  temporary  use  m  warm  countries, 

when  light  board-structures  or  those   of  bamboo  and 

palm  are  used.    In  the  latter  class,  cheapness  of  cost 

is  always  a  consideration ;  but  it  is  not  to  be  carried 

to  the  extent  of  making  the  structures  unsanitary.    Suf- 


THE  HYGIENE   OF  THE  BARRACKS        55 

ficieut  room  should  be  provided,  adequate  and  conven- 
ient supplies  of  good  water,  proper  kitchen  arrange- 
ments, and  protection  from  mosquitoes,  flies,  and  other 
insect  pests.  The  structures  should  be  sufficiently  raised 
above  the  ground  to  prevent  dampness,  if  possible,  and 
ample  provision  should  be  made  for  the  care  of  excreta, 
garbage,  and  waste  water. 

In  permanent  barracks  of  the  newer  type,  provision 
has  usually  been  made  for  the  sanitary  requirements, 
and  the  conditions  are  satisfactory  where  overcrowd- 
ing does  not  obtain.  Barracks  of  concrete,  stone,  brick, 
or  wood  may  all  be  satisfactory  if  other  considerations 
are  met.  One  of  the  first  of  these  is  location  and  ex- 
posure, and  the  desirable  locations  and  facings  vary 
with  climate  and  local  conditions. 

In  general,  it  is  well  to  get  much  exposure  to  the 
sun  in  cold  climates,  and  this  is  best  accomplished  by 
having  the  four  corners  of  the  main  building  point 
in  the  cardinal  directions.  In  such  places,  however, 
the  avoidance  of  prevailing  winter  winds  may  be  of 
even  greater  importance,  and  may  dictate  a  location. 
In  any  event,  both  sun  and  wind  must  be  considered  in 
their  sanitary  as  well  as  their  comfort-bearing  capacities, 
the  former  as  a  great  aid  in  cleanliness  and  disinfec- 
tion, the  latter  as  a  promoter  of  ventilation.  In  any 
climate,  the  structures  should  be  dry  as  to  both  site 
and  walls.  Damp  cellars  and  surroundings  may  be 
avoided  by  selection  or  by  grading  and  drainage.  Damp 
walls  are  avoided  by  having  a  damp-proof  course,  as 
of  slate  or  concrete,  above  the  foundations,  by  double 
walls  with  air-spaces,  by  good  ventilation,  and,  where 
excessive  or  hard-driven  rains  obtain,  by  waterproofing 
with  paint,  etc.  If  the  walls  are  continuously  of  porous 


56    THE  RECRUIT  AND  HIS   ENVIRONMENT 

brick  or  stone  to  the  cellar,  or  to  the  surface  of  the 
ground,  they  will  be  continuously  damp  and  chilly,  in 
most  climates,  and  only  the  insertion  of  a  damp-proof 
course  will  correct  the  condition.  If  other  considera- 
tions, such  as  size,  ventilation,  heating,  or  plumbing, 
are  unequal,  they  should  be  allowed  more  weight,  in 
governing  the  choice  of  barracks,  than  the  structural 
material ;  if  all  other  considerations  are  equal,  the 
structural  feature  should  govern  choice,  usually  in  the 
following  order :  concrete,  brick,  stone,  wood. 

The  buildings  should  be  sufficiently  large  to  provide 
abundant  squad  room,  recreation  or  day  rooms,  store- 
_  rooms,  kitchen,  pantry,  and  dining-rooms, 

small  rooms  for  noncommissioned  officers, 
tailor's,  barber's,  and  cobbler's  shops,  a  workshop  for 
the  mechanics,  and  ample  water-closet  and  bathing 
facilities,  unless  a  part  of  these  are  provided  else- 
where. 

The  squad-rooms  are  the  matter  of  greatest  consid- 
eration, and  they  should  be  given  first  thought  in 
selecting  barracks.  They  should  always  be  as  large  as 
it  is  possible  to  obtain,  keep  clean,  and  heat,  and 
should  provide  a  minimum  of  six  hundred  cubic  feet 
of  space  and  sixty  square  feet  of  floor-room  for  each 
man,  exclusive  of  the  room  occupied  by  wardrobes  and 
lockers.  They  should  be  well  lighted  both  by  windows 
and  artificial  light,  preferably  electric.  The  window- 
space  necessary  will  vary  with  climate  and  location, 
but  it  should  insure  plenty  of  breeze  in  the  tropics, 
and  plenty  of  light  in  northern  climates.  If  a  good 
systemof  ventilation,  other  than  by  windows  and  doors, 
has  been  installed,  so  much  the  better,  and  it  should 
be  carefully  studied  until  understood,  and  then  kept  in 


THE  HYGIENE  OF  THE  BARRACKS        57 

maximum  working  order.  In  all  barracks,  ventilation 
and  heating  are  closely  related,  and  should  receive  the 
company  commander's  personal  consideration.  If  it 
be  practicable,  it  is  a  great  help  in  ventilating  most 
barracks  to  have  a  small  open-grate  fire  going  all  win- 
ter, but  there  is  usually  no  provision  for  it.  The  air  in 
the  squad-rooms  should  at  all  times  be  sweet  and  fresh, 
and  free  from  the  "  closeness "  and  staleness  that  is 
particularly  apt  to  obtain  in  the  early  morning  hours 
of  winter  nights.  The  means  of  insuring  this  will  vary 
in  different  places,  but  there  is  always  one  expedient 
that  may  be  resorted  to,  —  raising  the  lower  window- 
sashes  and  fixing  boards  beneath  them,  with  nails  if 
necessary,  so  as  to  allow  the  air  to  enter  in  an  upward 
direction  between  the  two  sashes.  Inspections  should 
be  made  occasionally,  at  the  times  indicated,  to  see  that 
the  air  is  good;  while  all  arrangements  to  promote 
ventilation  should  be  inspected  frequently  to  see  that 
they  are  in  working  order  and  have  not  been  interfered 
with.  In  case  interference  is  found,  it  is  well  to  detail 
a  man  in  each  room  to  be  responsible  for  their  correct 
maintenance.  All  squad-rooms  should  be  opened  and 
thoroughly  aired  each  day,  in  addition  to  the  constantly 
working  arrangements. 

Always  in  the  tropics,  and  during  warm  weather  in 
other  climates,  all  windows  should  be  provided  with 
screens  to  exclude  flies  and  mosquitoes.  If  such  is  not 
the  case,  bed-nets  must  be  used  at  night. 

In  cold  climates  double  or  storm  doors  and  windows 
may  be  provided.  They  make  the  rooms  more  com- 
fortable and  easier  to  heat,  but  should  not  be  allowed 
to  impair  the  ventilation. 

Water-closets,  bath-rooms,  and  wash-basins  should 


58    THE  KECRUIT  AND  HIS   ENVIRONMENT 

be  entirely  away  from  the  squad-rooms,  in  which  no 
plumbing  should  show.  Articles  of  food,  dirty  and  wet 
clothing,  and  useless  trappings  should  be  excluded  as  far 
as  practicable.  Floors  should  be  sprinkled  frequently 
with  wet  sawdust,  and  swept  so  as  to  create  as  little  dust 
as  possible;  and  at  least  once  a  week  the  entire  room 
and  its  contents  should  be  so  thoroughly  cleaned  as 
to  pass  the  most  rigid  inspection,  no  dirt,  no  dust,  no 
disorder,  no  vermin  being  anywhere  present.  This  in- 
spection will  be  made  on  Saturday,  and  should  be  pre- 
ceded by  an  outdoor  airing  of  bedding  and  change  of 
bed-linen  on  Friday.  At  the  inspection  all  wardrobes, 
drawers,  lockers,  and  boxes  should  be  opened,  and 
their  contents  exposed  to  view.  The  small  spaces  and 
corners  about  such  articles,  the  space  behind  or  under 
radiators,  the  tops  of  wardrobes  and  shelves,  should  all 
be  examined,  and  if  any  man  seem  unclean,  his  linen 
and  person.  It  is  not  thought  wise  to  subject  intelligent 
and  self-respecting  men  to  such  personal  inspections 
as  a  matter  of  routine. 

The  day-rooms,  or  recreation-rooms,  should  be  suit- 
able for  their  purpose,  should  have  good  light,  good 
air,  comfortable  heating,  and  such  provision  in  the 
way  of  chairs,  tables,  reading  matter,  billiard  and  pool 
tables,  and  other  facilities  for  amusements,  as  will  con- 
duce to  the  interest,  instruction,  and  amusement  of  the 
men,  or  such,  at  any  rate,  as  can  be  obtained. 

These  rooms  should  be  kept  clean  and  neat  at  all 
times,  free  from  dust,  foul  air,  dirt,  and  vermin.  The 
care  should  be  such  as  to  enable  them  to  pass  the  same 
general  inspection  as  squad-rooms.  Smoking  will  be 
indulged  in,  in  recreation-rooms,  at  most  times  of  day, 
but  the  rooms  should  be  opened  and  aired  frequently. 


THE  HYGIENE  OF  THE  BARRACKS        59 

Spitting  will  also  be  indulged  in,  and  cuspidors  con- 
taining water  should  be  provided  in  sufficient  numbers 
to  prevent  spitting  on  the  floor,  and  any  man  then 
doing  so  should  be  punished.  The  cuspidors  should  be 
emptied  and  scrubbed  daily. 

Pictures  and  ornaments  may  be  permitted  to  some 
extent,  to  detract  from  the  bareness  and  add  to  the 
cheerfulness  of  the  room ;  but,  in  general,  unnecessary 
dust-collecting  articles  should  be  excluded. 

The  dining  or  mess  room  should  be  sufficiently  large 
to  seat  comfortably  at  table  at  least  ninety  per  cent  of 
the  command.  A  certain  number  of  men  will  necessarily 
be  absent  from  each  meal,  —  on  guard,  in  the  kitchen, 
on  pass  or  furlough,  and  for  other  reasons,  —  but  pro- 
vision should  be  made  for  the  maximum  number  that 
may  be  present.  Lighting,  heating,  ventilation,  and 
screening  are  all  important  here  as  in  other  rooms. 
Screening,  particularly,  should  be  carefully  provided, 
and  every  means  employed  to  keep  the  place  free  from 
flies.  The  cleanliness  of  this  room  should  be  as  nearly 
perfect  as  possible,  and  while  it  is  permissible  to  have 
the  room  attractive,  dust-gathering  trappings  should 
be  excluded.  The  mess-tables  are  used  uncovered,  or 
covered  with  white  oil-cloth.  The  former  is  the  prefer- 
able method,  as  it  insures  thorough  cleaning  and  scrub- 
bing, if  the  tables  look  clean.  An  oil-cloth  can  be  made 
to  look  almost  or  quite  its  best  by  a  small  amount  of 
indifferent  rubbing,  though  it  really  may  not  be  free 
from  grease  and  dirt. 

As  said  before,  the  men  should  be  required  to  ob- 
serve the  decencies  at  table,  and  they  are  more  apt  to 
do  so  if  the  decencies  are  observed  toward  tliem.  The 
table  should  therefore  be  orderly  and  attractive,  though 


60    THE  RECRUIT  AND  HIS  ENVIRONMENT 

plain,  the  dishes  and  utensils  should  be  perfectly  clean 
and  arranged  in  a  proper  manner,  the  food  should  be 
served  in  an  orderly,  attractive,  and  appetizing  way,  and 
with  a  sense  of  fitness.  While  parlor  manners  may  not 
be  expected  in  the  barracks,  gross  indecencies  of  man- 
ner, speech,  or  action  should  be  prevented.  The  room 
and  table  should  be  well  cleaned  after  each  meal,  and 
the  dishes  and  utensils  should  be  carefully  inspected 
daily  and  their  perfect  cleanliness  assured.  Once  a 
week,  or  oftener,  the  tables  and  floors  should  be  thor- 
oughly scrubbed  with  lye  and  water,  and  vinegar-cruets, 
salt-cellars,  mustard-pots,  etc.,  well  washed  and  filled. 
In  warm  weather,  fly-paper  and,  if  necessary,  occasional 
fumigation  with  pyrethrum  fumes,  should  be  used  to 
supplement  the  screens. 

No  man  should  be  allowed  to  eat  with  unclean  hands, 
and  it  should  soon  be  a  matter  of  habit  for  all  men  to 
come  to  the  table  clean  as  to  hands  and  face,  and  neat 
in  appearance.  Leisurely  eating  and  thorough  mastica- 
tion should  be  encouraged. 

After  the  squad-rooms  the  hitchen  is  probably  the 
most  important  room  in  the  barracks.  Its  importance 
has  been  discussed  elsewhere,  but  may  be  emphasized 
here.  It  should  if  practicable  be  a  large  room,  well 
lighted  and  well  ventilated,  opening  on  a  large  porch, 
and  connecting  with  store-rooms  in  the  cellar  or  else- 
where convenient,  and  with  a  roomy  pantry,  with 
abundance  of  shelving  and  drawers,  also  well  lighted 
and  ventilated.  Good  tables,  sinks,  running  water, 
ample  drainage,  sound  and  smooth  meat-block,  an  amply 
large  range,  and  abundance  of  good  kitchen  furniture 
and  utensils  should  be  provided.  A  large  ice-chest  and 
some  screened  shelving  should  be  near  at  hand.    It  is 


THE  HYGIENE  OF  THE  BARRACKS        61 

desirable,  if  practicable,  to  have  a  large  hood  over  tlie 
range,  to  catch  and  conduct  away,  through  a  ventilating 
shaft,  the  odors,  vapors,  and  smoke  arising  from  the 
cooking.  All  of  these  articles  should  be  frequently  in- 
spected to  make  sure  that  they  are  always  cleaned  as 
soon  as  possible  after  use,  and  never  put  away  in  any 
other  condition.  The  cook,  above  all  men  in  the  com- 
pany, should  live,  think,  and  dream  cleanliness,  and  he 
should  be  held  most  strictly  to  account  for  shortcom- 
ings in  that  line.  The  kitchen  police  should  be  re- 
warded for  efficiency  in  such  a  way  as  to  make  the 
detail  desirable,  and  in  this  way  the  kitchen  should  be 
made  an  object-lesson  and  a  school  of  cleanliness.  The 
inspection  of  the  kitchen  should  include  the  pantry 
and  ice-chest,  should  take  note  of,  and  remedy,  waste  or 
poor  management,  and  should  always  embrace  inquiries 
concerning,  and  search  for,  flies,  roaches,  mice,  and  other 
vermin.  Cats,  dogs,  and  other  pets,  as  well  as  men  not 
there  on  duty,  should  be  excluded  at  all  times.  Garbage- 
cans  should  be  outside  of  the  kitchen,  should  be  emptied 
at  least  once  a  day,  and  then  cleaned  inside  and  out ; 
otherwise  they  speedily  become  a  foul  nuisance. 

The  general  remarks  as  to  the  lighting,  heating,  ven- 
tilation, and  cleanliness  apply  to  the  offices  and  the 
shop-rooms  for  the  baker,  tailor,  and  cobbler,  and  the 
inspection  of  these  latter  should  not  be  omitted,  other- 
wise they  are  especially  apt  to  form  accumulations  of 
scraps,  dirt,  and  dust ;  and  they  are  especially  favorable 
distributing  points  for  vermin. 

The  company  barber  should  be  required  to  keep  his 
brushes,  combs,  razors,  and  utensils  thoroughly  clean, 
and  to  sterilize  them  frequently.  lie  should  be  obliged 
to  keep  an  abundance  of  clean  towels  and  aprons,  and 


62    THE  RECRUIT  AND  HIS  ENVIRONMENT 

to  be  liberal  in  their  use.  He  is  not  apt  to  be  so  of  his 
own  volition.  He  should  be  instructed  not  to  shave  or 
cut  hair  for  men  with  skin  diseases  without  first  get- 
ting the  surgeon's  assent.  Should  his  own  skin  or  hands 
show  disease,  he  should  consult  the  surgeon. 

Store-rooms  do  not  need  light,  air,  and  heat  in  such 
liberal  amounts  as  do  living-rooms,  but  they  should  be 
dry,  free  from  vermin,  and  should  answer  the  purposes 
for  which  they  are  required. 

Bath-rooms  should  be  well  drained,  well  ventilated, 
and  well  lighted,  and  when  such  is  not  the  case  every 
effort  should  be  made  to  correct  the  condition.  Lighting 
is  facilitated  and  cleanliness  promoted  by  having  walls, 
doors,  and  partitions  painted  white.  Where  tubs  are 
installed,  they  should  be  thoroughly  washed  and  cleaned 
after  each  use,  and  the  floor  should  be  kept  clean  at  all 
times.  Each  man  should  have  his  own  soap  and  towels, 
and  should  take  them  to  and  from  the  tub  with  him. 
When  tubs  are  not  sufficiently  numerous  to  accommo- 
date the  men  as  they  wish  to  go,  they  should  be  detailed 
by  roster  to  bathe,  at  least  once  or  twice  a  week,  and 
as  much  should  always  be  required  of  them.  Shower- 
baths  are  much  more  economical  of  both  time  and  water, 
and  are  installed  at  most  posts.  They,  as  well  as  tubs, 
should  have  both  hot  and  cold  water  connections,  be 
frequently  inspected  as  to  condition,  and  be  kept 
scrupulously  clean.  The  drain  openings  should  not  be 
allowed  to  clog  with  soap  and  hairs,  and  the  entire  bath- 
room should  be  scrubbed  at  least  once  a  week,  and  as 
much  oftener  as  is  necessary  to  keep  it  clean  and  sweet- 
smelling,  and  free  from  mustiness.  Gratings  should  be 
lifted  daily  if  necessary  and  the  space  beneath  flushed 
and  scrubbed.    The  same  general  remarks  apply  to  the 


THE  HYGIENE  OF  THE  BARRACKS        63 

bowls  for  face  and  hand  washing.  The  stoppers  for 
these,  and  the  chains  holding  them,  should  always  be 
clean,  the  outlet  openings  likewise,  and  watch  should 
be  kept  to  prevent  the  formation  of  a  film  or  coat  of 
soap  and  dirt  inside  the  bowls.  The  throwing  of  to- 
bacco, paper,  cotton,  and  dressings  into  bowls,  tubs,  or 
bath  compartments  should  be  forbidden  and  prevented. 
The  man  detailed  in  charge  of  the  bath-room  should  be 
cleanly  and  trustworthy,  and  should  have  authority  to 
enforce  the  rules. 

The  water-closets  are  frequently  in  close  proximity 
to  the  bath-room,  and  if  both  are  kept  clean  there  is  no 
objection  to  it.  Flush-closets  and  urinals  are  installed 
in  practically  all  posts  now,  and  where  such  is  not  the 
case  one  of  the  various  expedients  for  disposing  of  ex- 
creta in  the  field  will  have  to  be  used,  and  reference  is 
made  to  their  description.  Flush-closets  should  be  kept 
clean  at  all  times,  the  bowls  scoured,  and  the  seats 
wiped  off  occasionally  with  a  damp  cloth.  The  floors 
about  them  should  always  be  clean,  and  the  room  should 
be  free  from  odor.  Standing  on  the  seats,  defacing  or 
defiling  them,  throwing  stiff  paper,  matches,  and  other 
things  likely  to  cause  obstruction,  into  the  bowl,  and 
writing  obscenity  on  the  compartment  walls  should  be 
punishable  offenses.  When  a  closet  gets  out  of  order 
in  any  way,  it  should  be  put  out  of  use  until  repaired. 

It  is  to  be  borne  in  mind  that  the  use  of  carbolitj  acid 
and  chloride  of  lime  is  but  rarely  necessary  about  flush- 
closets,  and  then  not  for  the  purpose  of  destroying  odors. 

Constant  bad  odors  indicate  lack  of  care  or  poor 
plumbing,  or  both,  and  should  be  corrected.  When 
concealed  by  other  odors,  such  as  those  of  chlorine 
or  carbolic  acid,  they  may  not  be  noticed,  but  the  evil 


64    THE   RECRUIT  AND  HIS   ENVIRONMENT 

condition  of  which  they  gave  warning  is  unremedied. 
Tissue  paper  is  issued  for  toilet  purposes,  and  no  other 
should  be  permitted  to  be  used,  as  being  apt  to  scratch 
or  irritate  the  anus,  and  to  clog  the  drain.  By  signs 
in  the  room,  and  by  verbal  instruction,  the  men  should 
be  taught  to  wash  the  hands  after  every  visit  to  the 
closet.  It  should  also  become  a  habit  for  them  to  inspect 
their  feces  before  flushing  the  closet,  as  disorders  may 
thus  be  brought  to  their  attention,  and  remedies  sought. 
The  passage  of  blood,  pus,  large  amounts  of  mucus,  or 
worms  should  prompt  early  consultation  of  the  surgeon. 
The  closet-rooms  should  be  screened,  and  should  be 
floored  with  cement  to  permit  flushing,  and  to  do  away 
with  cracks  and  crevices.  Roaches  and  flies  should  be 
excluded.  Each  is  indicative  of  unsatisfactory  condi- 
tions. Urinals  are  ordinarily  flush-bowls,  for  use  by 
one  person  at  a  time,  and  should  be  sufficiently  numer- 
ous to  meet  the  demands  of  early  morning  and  of  the 
evening.  The  floor  and  walls  immediately  about  them 
should  be  of  smooth,  hard,  waterproof  material,  such  as 
slate,  and  should  be  washed  thoroughly  each  day  and 
then  lightly  wiped  with  a  moist  rag  sprinkled  with  kero- 
sene. Otherwise  a  crust  of  urinary  salts  is  apt  to  form, 
and  odors  of  decomposing  urine  to  arise.  When  proper 
care  and  cleanliness  are  exercised,  neither  of  these  ap- 
pear, and  the  use  of  deodorants  is  not  necessary.  The 
flushing  of  the  bowls  is  usually  automatic,  and  should  be 
of  sufficient  frequency  to  prevent  deposition  of  salts, 
though  its  action  should  be  supplemented  by  washing 
and  scrubbing  of  the  bowl.  If  the  outlet  of  the  bowl  is 
not  already  screened,  a  piece  of  wire  gauze  should  be 
placed  over  it  and  held  in  place  by  a  small  stone  or 
other  weight,  otherwise  it  may  get  clogged  with  bits  of 


THE   HYGIENE  OF  THE  BARRACKS        65 

cotton,  cigarette-stumps,  and  other  waste  thrown  into 
the  bowl.  The  throwing  of  such  articles  into  urine  bowls 
should  be  punished,  if  detected,  but  detection  is  not 
usual. 

It  is  neither  desirable  nor  practical  to  have  the  men 
do  their  own  laundry-work  in  barracks,  but  a  couple  of 
tubs,  running  water,  and  scrub-brushes  should  be  pro- 
vided, if  possible,  to  enable  them  to  do  a  certain  amount 
of  emergency  work  and  cleaning. 

The  company  commander  should  familiarize  himself 
with  the  system  of  plumbing  in  his  barracks,  with  a 
view  both  to  detecting  leaks  and  other  faults,  and  to 
taking  action  for  the  institution  of  improvements  where 
indicated,  and  likewise  to  fit  himself  to  distinguish 
between  poor  plumbing  and  inefficient  care  of  good 
plumbing. 

The  water-supply  of  the  barracks  should,  if  possible, 
be  of  water  fit  for  drinking  without  boiling  or  other 
special  preparation.  If  this  is  not  the  case, 
the  men  should  be  warned  and  the  proper 
drinking  supply  carefully  defined  and  lo-  '^^^  ^ 

cated.  The  general  supply  should  be  abundant  for  all 
purposes,  and  should  amount  to  one  hundred  gallons  per 
man  per  day,  though  so  much  need  not  ordinarily  be 
used,  and  the  amount  really  used  will  depend  on  a 
number  of  varying  factors,  such  as  temperature  and 
climate,  the  character  of  the  work  done  by  the  men, 
the  care  used,  economy  exercised,  and  the  condition  of 
the  plumbing. 

Where  tub-baths  are  used,  the  consumption  will 
be  greater  than  if  showers  are  used.  While  care 
should  be  exercised  to  prevent  waste,  it  is  usually 
false  economy  to  hinder  any  reasonable  use  of  water, 


66    THE  RECRUIT  AND   HIS  ENVIRONMENT 

as  in  bathing,  scrubbing,  watering  plants  or  grass,  or 
laying  dust. 

The  water  should  be  piped  to  the  kitchen,  the  bath- 
rooms, water-closets,  urinals,  wash-basins,  furnace-room, 
and  to  such  places  in  and  about  the  building  as  may  be 
necessary  for  police  purposes  or  fire  protection.  All 
faucets,  exposed  pipes  and  fire-plugs,  and  other  parts 
of  the  water-supply  apparatus,  should  be  frequently  in- 
spected for  leakage  and  as  to  their  working  condition. 

Except  in  the  ways  indicated  above,  the  water-sup- 
ply in  barracks  is  not  usually  controlled  by  the  com- 
pany commander. 

Good  plumbing  presupposes  good  materials,  and  such 
are  usually  furnished.  Iron  pipe  should  conduct  the 
-5,       ,  water-supply,  and  all  joints  should  be  tight. 

Faucets  are  usually  of  brass,  and  with  pro- 
per  usage  rarely  need  repairs,  except  new 
washers.  Lead  pipe  is  objectionable  as  being  liable  to 
cause  lead-poisoning.  Some  water  after  a  time  will  cause 
the  pipes  to  fill  partially  or  entirely  with  a  deposit  of 
mineral  salts,  or  a  growth  of  low  vegetable  forms,  with 
a  consequent  lessening  of  the  size  of  the  stream.  Such 
conditions,  as  well  as  advanced  erosion,  may  necessitate 
renewal  of  the  pipe.  Kitchen  sinks  and  wash-bowls 
should  have  their  outlet-pipes  and  traps  exposed  and 
open  to  inspection,  not  closed  in  to  become  musty 
hiding-places  for  roaches.  Kitchen  sinks  are  usually 
made  of  galvanized  or  enameled  iron  or  zinc,  wash- 
bowls of  enameled  iron  or  porcelain.  In  any  event, 
the  surface  should  be  smooth  and  capable  of  complete 
cleaning. 

All  should  be  effectively  trapped  to  prevent  the  re- 
gurgitation of  air  or  gas  from  the  drains.  Sinks  should 


THE  HYGIENE   OF  THE  BARRACKS        67 

preferably  have  grease-traps,  which  should  be  easy  to 
open  and  clean. 

All  bath-tubs  should  be  of  enameled  or  porcelain- 
lined  iron  or  of  zinc,  and  closet  and  urinal  bowls  of 
enameled  iron  or  porcelain.  All  should  be  thoroughly 
trapped,  and  ventilated  on  the  ground  side  of  the  trap, 
by  communicating  with  the  ventilating  pipe.  No  odor 
should  come  from  them,  and  they  should  flush  freely 
and  effectively  on  all  occasions.  Whenever  one  of  them 
is  found  at  all  out  of  order,  flushing  poorly  or  imper- 
fectly, or  emptying  slowly,  it  should  be  put  out  of  use 
until  the  fault  is  corrected.  Such  trouble,  more  often 
than  not,  comes  from  the  use  of  newspaper  as  toilet- 
paper,  or  the  throwing  of  matches  and  other  improper 
objects  into  the  bowls.  Any  leaking  from  a  closet, 
urinal,  or  drain  should  be  immediately  corrected,  as 
especially  apt  to  cause  disease.  The  maintenance  of 
thorough  cleanliness  in  the  closet  is  incidentally  the 
most  ready  way  of  learning  of  such  defects,  while  the 
faults  arising  fi'om  its  neglect  are  at  times  unjustly  at- 
tributed to  the  plumbing. 

Of  the  various  systems  of  lighting  in  use  in  our  bar- 
racks, electricity  is  by  far  the  best.  Both  oil  and  gas 
consume  and  contaminate  the  air,  produce  -  .  ,  . 
dirt  and  much  heat,  may  be  blown  out,  and 
give  relatively  poor  light.  Electric  lighting  produces 
no  dirt,  neither  consumes  the  oxygen,  nor  adds  to  the 
combustion  products  in  the  rooms,  produces  very  little 
heat,  cannot  be  blown  out,  and  gives  a  brilliant,  steady 
light  that  is  very  much  better  than  either  of  the  others. 
The  danger  of  explosion  is  absent,  and  that  from  fires 
is  reduced  to  a  minimum  by  proper  wiring.  The  lights 
should  be  sufficiently  numerous  to  illuminate  well  all 


68    THE  RECRUIT  AND  HIS   ENVIRONMENT 

parts  of  the  building,  while  in  the  reading  and  recrea- 
tion-rooms they  should  be  numerous  enough  and  placed 
low  enough  to  make  reading  and  writing  practically  as 
easy  as  in  the  daytime.  Dull  and  flickering  light,  such 
as  is  often  produced  by  gas  or  oil,  is  very  trying  to  the 
eyes,  and  causes  strain  and  fatigue ;  while  the  vitiation 
of  the  air  by  the  combustion  of  these  substances  neces- 
sitates much  more  liberal  ventilation,  or  causes  suffer- 
ing. Economy  in  lighting  should  be  practiced  by  ex- 
tinguishing lights  when  the  necessity  for  their  use  has 
passed,  as  in  the  dining-room  and  kitchen  after  they 
are  cleaned,  in  the  squad-room  late  in  the  evening,  thus 
having  more  for  use  in  recreation-rooms. 

As  stated  earlier,  the  subjects  of  ventilation  and  heat- 
ing are  so  intimately  connected  that  no  consideration 
„       .  of  the  one  is  complete  unless  it  includes 

the  other.  This  is  so  for  the  reason  that 
gravity  is  the  most  important  factor  in  ventilation,  and 
the  weight  of  a  given  volume  of  air  is  less  or  greater  as 
it  is  warm  or  cold.  In  other  words,  we  influence  or  con- 
trol gravity  by  means  of  artificial  heat.  The  same  force 
is  the  principal  factor  concerned  in  the  diffusion  of 
heat  and  heated  air  throughout  barracks. 

In  summer,  doors  and  windows  can  be  kept  open,  and 
ventilation  is  seldom  a  very  serious  problem ;  but  in 
winter  or  very  cold  weather,  when  doors  and  windows 
are  closed  and  all  the  outside  air  is  so  cold  that  its  im- 
pact causes  discomfort,  the  case  is  different. 

Open  fires  are  suitable  for  heating  single,  small 
rooms,  but  not  large  ones,  though  the  presence  of  an 
open-air  fire  aids  in  the  ventilation  of  the  latter  as  well 
as  adds  its  cheer. 

Stoves  give  more  heat  and  less  ventilation,  for  the 


THE  HYGIENE   OF  THE   BARRACKS        69 

same  amount  of  fuel  used,  than  do  open  fires.  They 
may  be  made  to  promote  ventilation  greatly  by  being 
surrounded  by  a  sheet-iron  cylinder  or  jacket,  into 
which  a  fresh-air  shaft  empties  at  the  bottom.  The 
air  is  warmed  as  it  enters,  and  rises  into  the  room 
through  the  top  of  the  cylinder,  and  later  escapes  by 
way  of  stove-door,  window-cracks,  and  sundry  other 
outlets,  including  outlet-shafts,  if  such  are  provided. 

The  inlet  should  be  screened  to  keep  out  dust  and 
dirt,  and  the  top  of  the  stove  or  of  the  cylinder  should 
always  be  provided  with  an  open  vessel  of  water,  to 
moisten  the  air  by  its  evaporation. 

Cast-iron  stoves  give  off  carbon  monoxide,  a  poison- 
ous gas,  when  red-hot,  and  may  so  do  harm.  The  air 
used  in  the  combustion  of  fuel  is  taken  from  the  room 
and  passes  up  the  chimney,  fi-esh  air  replacing  it  from 
the  outside,  and  quite  satisfactory  ventilation  may  at 
times  be  so  maintained,  even  with  unjacketed  stoves, 
but  it  is  not  wise  to  rely  on  such  means  alone,  especially 
in  crowded  barracks.  Slow-burning  stoves,  such  as  an- 
thracite base-burners,  exercise  much  less  influence  in 
this  way  than  rapid-burning  wood  or  soft-coal  stoves. 

Hot-air  furnaces  operate  by  heating  fresh  air,  which 
is  brought  to  them  through  a  ventilating  shaft  from  the 
outside,  and  which,  when  heated,  rises  through  the 
tubes  and  passages  to  the  registers,  whence  it  passes 
into  the  rooms.  One  advantage  of  this  method  of  heat- 
ing is  that,  with  increased  heat,  in  very  cold  weather 
it  sends  up  an  increased  amount  of  fresh  air.  This  air, 
though,  is  usually  very  dry  if  the  water-pan  of  the 
furnace  is  not  carefully  watched  and  kept  filled.  This 
is  due  to  the  fact  that  air  doubles  its  capacity  for  ab- 
sorbing moisture  with  each  increase  of  15°  C.  in  its 


70    THE  RECRUIT  AND  HIS   ENVIRONMENT 

temperature  ;  so  that  outside  air  which  at  zero  C.  does 
not  seem  dry  is  excessively  so  when  raised  to  25°  C. 
For  this  reason  all  systems  of  artificial  heating  should 
make  some  provision  for  moistening  the  heated  air ; 
which  otherwise  causes  discomfort  and  harm. 

The  method  of  heating  just  described  is  not  very  much 
used  in  our  barracks,  being  regarded  less  favorably 
than  the  steam  and  hot-water  systems. 

Steam-heating  is  very  satisfactory  and  is  much  used. 
In  this  system  the  heat  from  the  fire  is  transmitted 
to  water,  which  is  made  to  boil,  under  pressure  if  neces- 
sary, and  the  heat  is  carried  throughout  the  building 
by  the  steam,  which  travels  through  tight  iron  pipes 
that  expand  into  radiators  in  the  various  rooms.  It  is 
a  rapid  method  of  heating,  and  one  easily  controlled  by 
an  intelligent  man,  and  such  a  man  should  be  detailed 
in  charge  of  it.  He  should  maintain  an  even,  steady 
fire,  enough  steam  to  make  the  rooms  comfortable,  and 
keep  the  water  in  the  boilers  at  a  constant  and  proper 
level.  Such  plants  usually  show  their  maximum  effi- 
ciency when  a  steam  pressure  of  one  or  two  pounds  is 
maintained. 

Water  should  be  kept  evaporating  from  the  radi- 
ators, or,  with  a  good  man  in  charge  of  the  system, 
steam  may  be  allowed  to  escape  from  them  to  moisten 
the  air. 

Hot-water  Keating  is  somewhat  similar,  but  the  pipes 
are  filled  with  water  instead  of  steam.  It  is  a  very  steady 
method  of  heating,  but  slower  in  either  heating  or  cool- 
ing than  steam.  High  and  low  pressure  systems  are 
used,  only  the  latter  in  our  service. 

The  air  heated  by  the  radiators  is  dried  thereby,  and 
provision  should  be  made  for  moistening  it. 


THE  HYGIENE  OF  THE  BARRACKS        71 

When  steam  and  hot-water  heating  are  used,  they  are 
made  to  promote  ventilation  by  having  the  fresh  air 
enter  the  rooms  through  or  under  the  radiators.  It  is 
thereby  warmed  and  made  lighter,  and  at  once  rises,  to 
be  later  distributed  through  the  room  by  gravity,  con- 
vection, and  diffusion.  In  order  that  it  may  not  again  be 
drawn  through  the  radiators  and  redistributed,  a  line  of 
less  resistance  should  be  created  for  it  by  ventilating 
shafts  opening  near  the  floor  and  leading  to  the  roof,  or 
by  an  open  fire-place  to  answer  the  same  purpose. 

As  there  is  also  danger  of  fire  in  and  about  barracks, 
and  as  that  danger  is  increased  in  cold  weather,  all 
chimneys,  flues,  shafts,  stoves,  furnaces,  etc.,  should  be 
thoroughly  inspected  and  put  into  first-class  condition 
in  the  late  summer  or  early  fall,  before  fires  are  started. 
Competent  men  only  should  be  detailed  in  charge  of 
fires,  fire-drill  should  be  held  sufficiently  often  to  famil- 
iarize the  men  with  their  duties  in  case  of  conflagration, 
and  fire-buckets  filled  with  water  should  be  distributed 
about  the  buildings.  As  a  matter  of  cleanliness,  and  still 
more  as  a  matter  of  hygiene,  and  especially  in  the  trop- 
ics, this  water  should  be  renewed  once  or  twice  weekly, 
to  prevent  its  serving  as  a  breeding-place  for  mosqui- 
toes. Frequent  inspections  should  verify  the  thorough- 
ness and  effectiveness  of  this  measure. 

The  avoidance  of  mosquitoes,  flies,  roaches,  lice,  and 
other  vermin  has  already  been  shown  to  be  principally 
a  matter  of  screening,  cleanliness,  and  po- 
lice  ;  but  if  an  old  barracks  is  infested  with 
bed-bugs  or  fleas,  it  is  often  a  most  difficult  matter  to 
get  rid  of  them. 

The  most  effective  way  to  do  so  is  to  give  the  building 
and  furniture  a  thorough  overhauling,   scalding   out 


72    THE  RECRUIT  AND  HIS  ENVIRONMENT 

cracks  and  crannies  of  beds,  floors,  and  walls,  with  boil- 
ing water,  washing  them  with  five  per  cent  carbolic 
solution,  then  closing  all  cracks  with  putty  or  strips  of 
board,  and  painting  over  all.  Infested  clothing  or  bed- 
ding should  be  washed  or  steamed. 

Frequent  inspections  should  be  made  for  the  early 
detection  of  any  recurrence  or  reintrod action  of  the 
pests,  when  their  eradication  from  one  room,  or  even 
from  one  bed,  may  suffice  to  end  the  trouble. 


CHAPTER  V 

CAMPS 

The  soldier's  time  Is  partly  spent  in  camps,  and  occa- 
sionally the  periods  so  spent  may  extend  to  many  months. 
The  conditions  of  camp-life  are  in  many  respects  radi- 
cally different  from  those  in  barracks ;  the  old  sanitary 
problems  may  have  to  be  met  in  very  different  ways, 
while  new  ones  arise,  and  sickness  once  started  has 
opportunities  to  spread  such  as  are  not  offered  In  the 
barracks.  Our  own  unfortunate  experiences  in  the  camps 
of  concentration  in  1898  clearly  show  that  the  assem- 
blage of  large  bodies  of  raw  troops  into  great  camps  is  in 
itself  a  dangerous  matter,  and  that,  if  wise  care  Is  not 
exercised  to  prevent  it,  diseases  in  epidemic  form  may 
create  greater  havoc  than  the  enemy  In  arms.  It  is  the 
duty  of  the  medical  department  to  take  the  initiative, 
and  to  be  responsible  for  much  of  that  care ;  but  its 
work  can  only  be  made  effective  and  really  preventive 
of  disease  when  backed  by  the  Intelligent  and  sympa- 
thetic cooperation  of  the  officers  and  men  of  the  line. 
Plowever  great  may  be  the  powers  and  responsibilities 
of  the  medical  department  in  sanitary  matters,  they  can 
never  be  so  great  as  to  Interfere  with  some  urgent 
military  necessities,  or  to  free  it  from  the  need  of  the 
cooperation  mentioned.  It  Is  therefore  necessary  that 
the  company  officer  familiarize  himself  with  many  of 
the  sanitary  problems  presented  by  camp-life,  with  a 
view  to  teaching  his  men  to  take  proper  care  of  them- 
selves and  so  to  assist  him  and  the  sanitary  authorities 
in  maintaining  their  efficiency. 


74    THE  RECRUIT    AND   HIS  ENVIRONMENT 

At  times  the  choice  of  the  camp-site  will  devolve  upon 
the  company  commander,  at  other  times  a  site  is  assigned 
to  him  by  higher  authority,  and  he  has  no 
choice  in  the  matter.  It  is,  however,  usually 
within  his  power  to  improve  a  poor  site,  or  to  impair 
or  destroy  the  value  of  a  good  one  ;  and  whether  he  is 
more  likely  to  do  the  one  thing  or  the  other  depends 
largely  upon  his  knowledge  of  military  hygiene.  The 
genei'al  principles  regarding  the  selection,  arrangement, 
and  care  of  camps,  as  laid  down  in  the  Field  Service 
Regulations,  are  to  be  observed,  though  they  can  at 
times  be  improved  upon,  and  when  such  is  the  case  it 
should  be  done.  Let  it  be  remembered  that  from  a 
sanitary  standpoint  the  important  desiderata  are:  first, 
that  the  site  should  be  clean  and  healthful ;  second, 
that  it  should  be  kept  clean  and  free  from  infection 
during  its  occupancy ;  third,  that  it  should  be  left  so 
after  the  departure  of  the  troops. 

The  consideration  of  the  site  of  a  camp  must  include 
an  investigation  of  the  healthfulness  of  the  surrounding 
country,  and  in  certain  instances  a  very  desirable  site  is 
wisely  abandoned  for  one  apparently  less  so,  because  the 
health  conditions  may  be  known  to  be  better  in  the  lat- 
ter. For  example,  in  the  Bitter  Root  valley  in  western 
Montana  there  occurs  during  the  spring  months  a  fatal 
fever,  which  is  conveyed  by  the  bites  of  infected  ticks. 
These  are  found  principally  on  the  west  bank  of  the 
stream,  the  eastern  side  being  almost  free  from  the 
disease.  It  would  be  wise,  in  that  territory  and  at  such 
a  season,  to  forego  considerable  advantages  that  might 
be  found  on  the  western  side,  and  to  take  the  trouble  of 
crossing  the  stream,  rather  than  to  run  the  greater  risk 
of  infection  with  the  "  tick  fever."  A  somewhat  similar 


CAMPS  75 

disease  occurs  in  certain  river-bottoms  in  Japan,  and 
in  that  case  the  camp  could  be  safely  placed  on  the 
infected  side  of  the  stream,  above  all  levels  subject  to 
flooding^  as  the  infected  insects  are  met  with  only  at 
such  levels.  In  Africa  sleeping  sickness  is  transmitted 
by  a  fly  that  is  found  only  in  or  about  thick  underbrush 
close  to  water,  and  relapsing  fever  by  infected  ticks  that 
appear  principally  in  regular  rest-places  or  camps.  It  is 
possible  that  other  diseases  of  equally  strict  localization 
may  occur,  and  it  is  important  to  avoid  them  if  prac- 
ticable. 

The  qualities  desirable  in  a  camp-site  vary  somewhat 
with  the  season,  breeze  and  shade,  for  instance,  being 
desirable  in  summer  and  undesirable  in  winter.  The  site 
should  have  a  natural  slope,  to  insure  the  speedy  disap- 
pearance of  rain-water  from  tents  and  streets.  The  sur- 
face should  be  as  regular  and  smooth  as  can  be  obtained, 
free  from  numerous  rocks  and  hollows.  Stumps  and 
trees  are  at  times  objectionable,  particularly  if  numerous 
and  close  set,  but  at  other  times  they  can  be  put  to  a 
surprising  number  of  uses,  and  those  that  are  most  in 
the  way  will  disappear  in  a  short  time  after  the  camp  is 
made.  The  inequalities  of  surface  due  to  numerous  large 
roots  or  lightly  covered  rocks  are,  however,  harder  to 
overcome. 

The  soil  of  the  camp-site  should  be  dry  and  firm,  so 
as  not  to  give  rise  to  a  great  amount  of  dust  in  dry,  or 
mud  in  wet,  weather.  Clayey  soil,  if  the  surface  slopes 
gently  and  drains  speedily,  is  good.  Sandy  or  very 
soft  loam  is  undesirable,  and,  in  very  windy  seasons 
or  neighborhoods,  the  dust  it  gives  rise  to  may  be  a 
plague.  A  surface  well  set  with  grass  is  good,  if  not 
damp;    but  the  grass  will  soon  die  in  tents  and  be 


76    THE  RECRUIT  AND  HIS  ENVIRONMENT 

tramped  to  pieces  in  the  streets,  and  should  be  well 
cleaned  up.  The  neighborhood  of  marshes  or  standing 
water  should,  if  possible,  be  avoided,  principally  be- 
cause they  are  apt  to  be  infested  with  mosquitoes,  but 
also  because  the  ground  may  be  wet.  Ordinarily,  high- 
ground  water  (shown  by  its  nearness  to  the  surface  in 
wells  or  pits)  makes  for  insalubrious  conditions,  much 
as  do  marshes. 

Winds  may  be  desirable  or  the  reverse,  according  to 
circumstances.  In  regions  where  mosquitoes  are  abun- 
dant, a  prevailing  wind  blowing  them  away  from  the 
camp  is  a  great  comfort,  one  in  the  opposite  direction 
a  great  nuisance.  In  wintry  weather  a  strong  wind 
always  produces  discomfort,  and  in  summer  it  may  do 
so  because  of  the  dust  and  dirt  it  blows,  and  in  such 
circumstances  shelter  from  it  should  be  sought. 

As  sites  are  unhealthful  or  infected,  in  most  in- 
stances, either  because  of  the  presence  of  disease-carry- 
ing and  infected  insects,  such  as  mosquitoes  or  ticks, 
or  because  of  their  previous  infection  from  human  oc- 
cupancy, old  camps,  marshy  grounds,  and  places  apt 
to  present  the  conditions  mentioned,  should  be  avoided. 
While  other  things  than  germs  may  and  do  cause  dis- 
ease, they  can,  to  a  relatively  large  degree,  be  safely 
ignored  if  infection  be  prevented ;  and  the  original 
choice  of  the  camp-site  may  be  of  little  importance  as 
compared  with  the  measures  taken  for  such  prevention. 
While  the  avoidance  of  malarious  swamps  and  of  such 
disease-centres  as  have  been  mentioned  above  is  of  the 
greatest  importance  in  regard  to  certain  diseases,  espe- 
cially those  that  are  insect-borne,  it  is  usually  camp 
diarrhcea,  dysentery,  typhoid,  and  other  infections  dis- 
seminated  largely   by   man   himself   that   create   the 


CAMPS  77 

greatest  havoc  in  camps.  The  danger  from  these  usu- 
ally increases  with  the  length  of  time  the  camps  are 
occupied,  and  with  the  increased  opportunity  for  their 
defilement.  This  being  so,  bivouacs,  temporary  and  per- 
manent camps,  are  apt  to  be  defiled  in  an  increasingly 
dangerous  degree  in  the  order  named,  and  care  in  po- 
licing is  of  increased  importance  in  the  same  order, 
though  it  cannot  be  safely  neglected  in  any  of  them. 
Even  a  dirty  bivouac-ground  may  constitute  a  menace 
to  the  inhabitants  of  the  region,  to  other  troops  later 
following  the  same  route,  or  to  the  command  leaving 
it,  on  its  return  that  way. 

The  danger  of  infectious  diseases  is  lessened  by  at- 
tention to  the  following  points  :  — 

The  ordinary  shelter  of  the  camp  is  furnished  by 
tents,  which  may  be  of  any  of  the  varieties  issued  for 
the  service,  though  the  shelter-tent  is  only 
exceptionally  used,  in  one  camp,  for  more 
than  a  few  days  at  a  time.  All  tents  are  apt  to  be  hot 
in  summer  and  cold  in  winter,  objections  partly  met 
by  the  proper  use  of  tent-flies.  All  are  liable  to  be 
crowded,  and  the  air  to  contain  many  micro-organisms 
when  they  are  kept  closed.  This  can  be  met  by  thor- 
ough sunning  and  ventilation,  with  walls  raised,  for  a 
part  of  each  day  when  the  weather  permits,  and  by  the 
frequent  removal,  cleaning,  and  airing  of  all  blankets, 
clothing,  and  accoutrements  to  which  the  moulds  and 
other  organisms  adhere,  and  the  exclusion  of  articles 
in  or  on  which  they  may  grow,  such  as  food,  dirty 
straw,  trampled  grass,  empty  but  unclean  bottles,  cans, 
and  boxes.  All  tents  are  apt  to  be  damp  in  rainy  or 
wet  weather,  and  to  lessen  this  they  should  be  well 
ditched,  so  that  all  water  from  the  tent-walls  and  the 


78    THE  RECRUIT  AND  HIS  ENVIRONMENT 

surrounding  ground  is  carried  away  and  the  tent-floor 
kept  dry.  If  the  camp  is  to  be  occupied  for  any  con- 
siderable length  of  time,  board  floors  should  be  fur- 
nished, or  the  interior  be  filled  with  fine  gravel  and 
rammed,  while  company  streets  should  be  raised  and 
made  hard  and  smooth  by  pounding  or  rolling.^  If 
floors  are  used,  they  should  be  raised  occasionally  and 
the  space  beneath  thoroughly  cleaned  and  aired.  The 
general  tent  ventilation  is  also  important  in  promoting 
dryness.  Because  of  the  dampness,  men  should  always 
try  to  sleep  off  of  the  ground.  In  permanent  camps  they 
may  have  cots.  Straw  sacks  are  helpful,  but  they  also 
should  be  raised  if  practicable.  Cots  or  beds  may  be 
improvised  from  timber,  or  easily  from  bamboo,  in  a 
country  where  that  abounds.  Small  branches  of  pine  or 
other  evergreen  boughs  serve  to  make  a  well-ventilated 
and  comfortable  bed  where  they  are  found.  Boughs, 
cornstalks,  loose  straw,  or  dry  leaves  may  be  available 
in  bivouacs.  In  other  camps  than  bivouacs  these  ma- 
terials should  be  stirred  up  and  aired  daily  and  renewed 
before  they  become  mouldy  or  much  broken  up. 

Owing  to  the  crowding  in  camps  and  the  frequently 
poor  bathing  facilities,  the  opportunities  for  the  spread 
of  body-vermin  are  unusually  good,  and  all  precau- 
tions as  to  cleanliness,  clothes-washing,  and  steriliza- 
tion, if  necessary,  should  be  exercised  to  prevent  their 
introduction  and  dissemination.  Dogs,  cats,  and  other 
pets  should  be  excluded  from  tents  and  usually  from 
camps.  Mosquitoes  are  to  be  avoided  by  means  to  be 
considered  later,  but  if  they  are  present,  nets  must 

^  Sprinkling  the  streets  with  crude  petroleum  and  rolling'  them,  as 
is  now  done  in  parkways  and  some  other  public  roads,  might  prove  of 
value  in  permanent  or  semi-permanent  camps,  in  lessening  both  dust 
and  mud. 


CAMPS  79 

be  used.  Flies,  roaches,  rats,  and  mice  are  best  kept 
down  by  the  maintenance  of  such  good  police  that  they 
find  no  breeding-places,  and  no  access  to  food  in  or 
about  the  tents;  hence  the  exclusion  of  food,  boxes, 
cans,  etc.  In  some  places,  as  the  neighborhood  of  San 
Francisco,  the  camp  is  very  apt  to  be  full  of  fleas,  and, 
as  these  insects  do  not  stay  long  on  their  hosts  and 
breed  in  the  sand,  floors,  or  bedding,  cleanliness  of 
tents,  floors,  and  surroundings  is  most  important,  as 
the  young  live  on  decomposing  animal  and  vegetable 
matters  found  there.  The  adults,  however,  can  live 
only  on  liquid  food,  practically  only  on  blood. 

Because  of  ignorance,  laziness,  or  viciousness,  men  at 
times  urinate  in  or  near  tents  instead  of  seeking  urinals. 
The  offense  may  not  be  readily  detected,  but  it  is  none 
the  less  filthy  and  dangerous,  and  should  be  severely 
punished. 

Huts,  cabins,  and  dugouts  may  be  used  instead  of 
tents  in  long-established  camps,  particularly  in  cold 
climates  or  seasons.  Because  they  are  not  so  accessible 
to  light,  ventilation,  or  cleaning  as  are  tents,  even  closer 
and  more  frequent  inspections  and  greater  care  in  clean- 
ing are  necessary,  and  particularly  so  in  the  prevention 
or  elimination  of  vermin.  At  least  once  a  week  all 
clothing,  bedding,  accoutrements,  and  other  accumula- 
tions of  personal  belongings  should  be  moved  outside 
and  the  places  thoroughly  inspected  and  cleaned.  Such 
places  as  well  as  tents  will  require  heating  in  cold 
weather,  but  as  long  as  proper  precautions  are  taken 
against  fire  and  to  provide  for  the  escape  of  combustion 
products,  this  is  desirable,  as  promoting  dryness  and 
ventilation,  as  well  as  comfort.  Dryness  of  shelters  and 
abundance  of  fresh  air  should  be  assured  by  all  possible 


80    THE   RECRUIT   AND   HIS  ENVIRONMENT 

means,  and  to  every  man.  No  one  should  be  allowed  to 
spend  all  of  his  time  inside  hovering  over  a  stove,  but 
all  should  work  out-of-doors  a  part  of  each  day.  Wet 
clothes  should  be  dried  and  dirty  ones  washed  outside 
of  the  shelter,  if  it  be  at  all  practicable.  Men  with 
clothing  or  shoes  wet  from  rain,  snow,  or  slush  should 
change  them  for  dry  at  the  first  opportunity,  and  before 
lying  down  to  rest  or  sleep.  So  far  as  military  necessi- 
ties permit,  men,  even  those  on  guard,  should  be  al- 
lowed to  shelter  themselves  from  inclemencies  of  the 
weather,  and  to  overcome  the  results  of  over-exposure 
as  soon  as  possible,  and  by  other  means  than  alcohol, 
which  many  seem  to  regard  as  the  only  remedy. 

The  water-supply  to  permanent  or  semi-permanent 
camps  may  be  piped  throughout  them  and  delivered 
---  from  stand-pipes  conveniently  placed.    In 

other  instances,  it  will  have  to  be  hauled  or 
carried  from  wells,  cisterns,  streams,  and  other  sources 
of  supply,  to  the  place  of  consumption.  If  it  is  known 
to  be  good  and  free  from  infection,  it  may  be  drunk  as 
delivered ;  but  when  doubt  exists  as  to  its  purity,  and 
such  will  most  often  be  the  case,  it  must  be  boiled  or 
filtered  before  use.  Boiling  destroys  all  disease-produ- 
cing organisms  that  are  found  in  water,  and  renders  it 
safe.  Prolonged  boiling  (the  Field  Service  Regulations 
prescribe  it  for  20  minutes)  makes  assurance  doubly 
sure,  but  if  fuel  or  time  is  precious,  making  certain 
that  the  water  comes  to  the  boiling-point  once  may 
suffice,  as  that  will  destroy  the  organisms  of  typhoid, 
cholera,  and  dysentery.  But  it  is  at  best  a  time-con- 
suming process,  and  if  the  water  is  not  well  cooled  it  is 
not  so  refreshing,  and  men  seek  it  from  other  sources. 
Other  methods  of  purification  are  therefore  resorted 


CAMPS  81 

to,  and  of  these,  precipitation  and  filtering  by  means  of 
the  Darnall  filter  promises  to  be  simple,  rapid,  and  ef- 
fective. This  filter,  when  obtainable,  will  be  accom- 
panied with  printed  directions  for  its  operation,  and 
these  should  be  carefully  followed.  Whether  the  water 
be  boiled  or  filtered,  reliable  men  should  be  detailed  in 
charge  of  the  drinking  supply,  preferably  under  the  di- 
rection and  supervision  of  a  medical  officer,  and  should 
be  well  instructed  in  their  duties.  Forbes-Waterhouse 
sterilizers,  Berkfeld  filters,  and  other  means  of  purifi- 
cation, are  at  times  resorted  to.  Many  of  these  are 
valuable,  but  are  not  used  because  of  the  difficulty  of 
keeping  them  in  order  or  the  slowness  of  their  opera- 
tion. They  should  not  be  resorted  to  unless  their  work- 
ing and  results  are  understood,  and  the  line  officer  is 
advised  to  put  the  responsibility  for  the  purity  of  the 
water-supply  on  the  medical  officer,  and  then  to  lend 
him  every  assistance  in  assuring  it.  However  purified, 
the  drinking  water  should  be  kept  pure  and  protected 
from  all  sorts  of  contamination  until  used.  This  is  pro- 
vided for  in  the  directions  accompanying  the  Darnall 
filter,  but  special  arrangement  has  to  be  made  in  other 
cases.  A  simple  and  effective  way  of  doing  it  is  to  have 
one  drinking-place  for  each  company,  and  to  have  at 
that  place  two  or  three  barrels  or  large  cans  fitted  with 
covers  and  with  faucets  near  the  bottoms.  Water 
should  be  boiled,  or  otherwise  purified,  and  run  into  one 
of  these,  covered,  and  allowed  to  cool.  When  cool  it  is 
marked  as  ready  for  use,  and  the  water  is  drawn  off  as 
needed  through  the  faucet.  Meanwhile  the  next  canful 
is  cooling.  AVhen  the  first  can  is  emptied,  it  is  rinsed 
out  with  boiling  water  and  refilled,  to  cool  while  the 
second  is  in  use,  and  so  on.      The    barrels  or   cans 


82    THE  RECRUIT  AND  HIS   ENVIRONMENT 

should  be  elevated  on  a  platform  so  that  the  faucet 
may  be  convenient,  and  a  soakage-pit  should  be  dug  be- 
neath the  drip  and  filled  with  small  stones  or  gravel 
to  prevent  the  formation  of  a  mud-puddle.  Waste  of 
the  water  should  be  discouraged,  but  if  it  amounts  to 
more  than  can  be  cared  for  by  the  pit,  which  should  be 
about  one  foot  deep  by  two  to  three  feet  square,  outlets 
a  foot  wide  and  six  inches  deep,  and  of  such  length  as 
necessary,  may  be  made  and  filled  also  with  stones  or 
gravel,  to  lead  away  the  excess  and  permit  of  its  ab- 
sorption. 

Outside  contamination  is  prevented  by  the  use  of 
the  tight-fitting  cover.  If  faucets  are  not  to  be  had, 
siphons  may  be  improvised,  if  rubber-tubing  is  avail- 
able. Otherwise,  the  water  will  have  to  be  dipped.  If 
so,  a  clean  dipper  should  be  provided  for  the  purpose, 
and  the  water  emptied  from  it  into  the  drinking  ves- 
sels. No  cup  should  be  dipped  in  the  water  after  it 
has  been  contaminated  by  hands  or  mouth.  The  dipper 
should  be  scalded  from  time  to  time,  and  should  be 
kept  clean  in  every  way.  If  reliably  clean  ice  is  obtain- 
able, it  may  be  added  to  the  water.  If  its  quality  is 
doubtful,  it  ma)'^  be  packed  around  vessels  of  water, 
but  should  not  be  put  into  them.  The  general  care  of 
the  water-supply  as  prescribed  in  Field  Service  Regula- 
tions should  be  observed. 

There  are  no  tests  that  can  be  quickly  applied  that 
will  enable  a  medical  officer  to  pronounce  a  given 
water-supply  safe.  He  may  form  an  opinion  to  that 
effect  from  a  consideration  of  the  source  and  surround- 
ings of  the  supply,  but  any  idea  that  he  can,  by  a 
simple  and  quick  chemical  test,  or  a  microscopic  ex- 
amination of  it,  gain  positive  knowledge  that  it  is  pure 


CAMPS  83 

and  safe  is  fallacious,  and  should  not  be  entertained. 
If  the  supply  probably  receives  seepage  from  privies, 
stables,  or  homes,  or  washings  from  the  same,  or  drain- 
age from  near-by  cities  or  towns,  it  must  be  regarded 
as  unsafe ;  and  in  other  cases,  where  sources  of  con- 
tamination are  not  so  evident,  it  is  wisely  precaution- 
ary to  take  the  same  view.  In  fixed  camps  there  may 
be  opportunities  for  the  full  and  careful  examination 
of  water-supplies  ;  but  even  when  such  is  the  case,  and 
the  water  is  found  satisfactory,  the  condition  may 
change  in  a  day  because  of  some  accident  or  the  care- 
lessness of  one  or  a  few  men.  Boiled  water  should 
be  used  for  many  kitchen  purposes,  such  as  washing 
food-receptacles  and  such  foods  as  are  eaten  raw.  Boiled 
or  actually  boiling  water  should  be  furnished  the  men 
for  washing  their  mess-kits.  A  good  arrangement  is  to 
have  for  each  company  a  box,  a  row  of  large  kettles  of 
hot  water,  at  least  one  of  them  actually  boiling,  and 
a  small  mop  or  scrub-brush.  As  a  man  finishes  a 
meal,  he  takes  his  mess-pan  and  implements  to  the 
place  where  these  are,  scrapes  any  food-remnants  into 
the  box,  rinses  the  articles  clean  in  the  first  kettle, 
passes  to  the  second  and  there  scrubs  them  with  the 
brush,  and  then  scalds  them  in  the  boiling  water  of  the 
third  kettle.  Proper  provision  should  be  made,  by 
means  of  a  trough-container  or  otherwise,  to  prevent 
soiling  of  the  ground  with  l)its  of  food  or  greasy  water. 
The  water-supply  should  be  sufficient  to  provide 
baths  for  the  men.  If  the  camp  be  situated  on  a  stream 
or  other  body  of  water,  it  may  afford  proper 
facilities  in  warm  weather.   Where  such  is  ° 

not  the  case,  and  in  cold  weather,  special  provision  will 
need  to  be  made.    Such  provision  will  include  a  proper 


84    THE  RECRUIT  AND  HIS   ENVIRONMENT 

supply  of  water,  sheltered  and  warm  bathing-places, 
and  a  proper  disposal  of  the  dirty  water. 

The  supply  of  water  may  be  piped  to  the  bathing- 
place,  or  it  may  have  to  be  carried  there.  The  former 
condition  need  not,  ordinarily,  concern  the  company 
officer,  except  that,  if  the  water  as  delivered  is  very 
cold,  most  of  his  men  will  not  bathe  in  it  in  cold 
weather.  In  case  it  has  to  be  carried,  each  man  should 
carry  for  his  own  use,  and  economy  will  then  be  exer- 
cised. The  most  effective  use  is  then  made  of  the 
water  if  the  bather  first  scrubs  himself  from  a  basin, 
using  soap  and  a  rough  cloth,  and  later  rinses  off  the 
soap  with  a  shower,  which  may  be  improvised  by 
means  of  a  large  tin  can  and  a  piece  of  rope.  Warm 
water  should  always  be  available,  and  may  be  kept  so 
if  a  large  can  of  water  be  kept  over  a  fire  near  the 
bathing-place,  and  any  man  desiring  to  bathe  be  al- 
lowed to  take  from  it,  replacing  an  equal  amount  of 
cold  water.  A  sheltered  and  warm  bathing-place  may 
consist  of  a  room  in  a  convenient  building,  of  a  special 
house,  shed,  or  tent,  heated,  if  necessary,  by  a  stove,  an 
extemporized  brick  oven,  or  other  means.  The  floor 
should  be  hard  and  dry,  or  should  be  covered  with 
wooden  gratings  to  lift  one  above  the  waste  water.  If 
for  lack  of  time  or  other  reason  a  suitable  bathing- 
place  has  not  been  prepared,  and  if  it  be  cold  weather, 
hot  water  may  be  furnished  and  men  allowed  to  take 
baths  in  their  tents.  In  such  cases  they  should  be 
careful  not  to  spill  water. 

If  bathing  is  possible  only  at  the  cost  of  considerable 
labor  or  inconvenience,  a  proportion  of  the  men  will 
neglect  it,  and  it  is  therefore  desirable  that  a  proper 
place  be  provided  and  the  men  required  to  bathe  at 


CAMPS  85 

least  once  a  week ;  while  the  feet,  face,  and  hands  should 
be  bathed  oftener,  and  facilities  should  be  provided  for 
that.  These  may  be  just  outside  or  inside  the  tents. 
The  disposal  of  waste  water  is  at  times  as  great  a 
problem  as  the  procuring  of  the  fresh  supply,  and  it 
will  have  to  be  solved  in  different  ways  under  different 
circumstances.  In  large  or  permanent  camps  under- 
ground drains  may  lead  it  away ;  at  other  times  trenches 
may  conduct  it  to  a  near-by  stream  or  to  dry  wells  or 
pits,  and  occasionally  it  may  be  necessary  to  collect  it 
in  barrels  and  haul  it  away.  Always,  care  should  be 
exercised  that  it  does  not  flow  or  soak  to  the  source  of 
supply  and  contaminate  that,  and  that  it  does  not  form 
breeding-places  for  mosquitoes.  Where  other  provision 
is  not  made,  fairly  satisfactory  results  may  usually  be 
obtained  as  follows:  A  suitable  space  inside  of  a  tent, 
say  five  or  six  feet  square,  is  dug  to  a  depth  of  four 
inches,  and  filled  with  gravel  or  fine  stone,  which  is 
rammed.  Over  this  a  wooden  grating  is  placed,  and 
on  the  grating  the  men  bathe.  From  the  lower  side  of 
the  space,  trenches  four  inches  deep  and  a  foot  wide  are 
dug  and  filled  with  gravel  or  stones,  and  they  conduct 
the  water  downhill  to  an  open  trench  that  leads  it 
away,  or  to  a  soakage-pit  about  a  yard  square  and 
deep,  or  larger  if  necessary,  that  is  filled  with  large 
rocks,  whence  it  soaks  into  the  ground.  Such  pits,  if 
in  porous  soil  or  gravel,  will  dispose  of  a  great  amount 
of  water  in  a  day.  If  in  clay  or  close-grained  soil,  their 
working  is  not  so  satisfactory,  and  it  may  do  better  to 
run  the  water  out  in  numerous,  shallow  surface-trenches 
from  which  it  can  evaporate.  Similar  precautions  may 
be  taken  to  provide  for  the  waste  water  from  drinking- 
troughs  for  animals. 


86    THE  RECRUIT  AND  HIS  ENVIRONMENT 

Facilities  for  washing  clothing  should  be  provided 
in  each  company,  though  they  need  not  be  more  elabo- 
rate than  a  supply  of  good,  and  preferably  warm,  water, 
a  board,  and  a  scrubbing-brush  and  soap.  The  waste 
water  may  be  disposed  of  as  indicated  for  bath-water. 
If  a  boiler  can  be  provided  for  clothes,  it  is  desirable 
to  have  it.  In  rainy  weather  a  heated  tent  should  be 
furnished  in  which  to  dry  them,  but  at  most  times  they 
can  dry  in  the  open. 

As  in  barracks,  so  in  camp,  the  kitchen  is  one  of  the 
most  important  parts  of  the  command,  and  on  its  proper 

.  administration  depends  much  of  the  cheer- 

fulness, health,  and  efficiency  of  the  men. 
The  food  should  be  abundant  and  good,  and  its  prepa- 
ration such  that  the  men  will  be  nourished  and  satisfied 
by  it,  and  not  under  the  temptation  to  gorge  themselves 
with  pies,  milk,  and  soft  drinks  of  doubtful  character 
from  outside  sources. 

The  mess  in  fixed  camps  may  be  made  quite  as  good 
as  in  barracks,  and,  except  in  rare  emergencies,  the 
articles  of  the  ration  are  both  good  and  abundant.  As 
the  problem  of  cooking  is  presented  somewhat  dif- 
ferently in  the  field  and  in  barracks,  the  company  com- 
mander, the  mess-sergeant,  and  the  cooks  should  all  study 
the  best  methods  for  field  service.  Some  excellent  gar- 
rison cooks  are  not  nearly  so  good  in  the  field,  while 
others  excel  there.  Economy,  good  management,  and 
cleanliness  are  as  important  in  the  field  as  elsewhere, 
while,  owing  to  the  outdoor  life  and  active  exercise,  the 
appetite  is  usually  increased  and  more  food  required. 
Owing  to  the  liability  of  chilling,  exposure  to  wet, 
and  the  greater  opportunities  for  intestinal  infection, 
irritating,  indigestible,  and  slightly  nourishing  foods, 


CAMPS  87 

such  as  green  corn  and  boiled  cabbage,  should  be  used 
sparingly,  while  green  or  overripe  fruits  should  be  for- 
bidden. In  the  presence  of  epidemics  of  intestinal 
diseases,  it  makes  for  safety  if  only  cooked  food  is 
eaten.  Underdone  cereals  or  vegetables  are  apt  to  cause 
indigestion,  and  as  they  are  more  difficult  to  cook 
thoroughly  in  the  field  because  of  the  trouble  with 
fires,  wind,  etc.,  particular  attention  should  be  paid  to 
them.  Rice,  beans,  hominy,  oatmeal,  and  potatoes  are 
probably  most  apt  to  be  underdone.  The  methods  of 
cooking  in  camp  are  various,  the  facilities  ranging  from 
the  most  simple  and  crude  to  the  elaborate.  Soup-carts, 
baking-ovens,  and  so-called  fireless  cookers  give  promise 
of  solving  some  of  the  problems ;  but  the  knowledge, 
industry,  and  management  of  the  company  commander, 
mess-sergeant,  and  cooks  must  be  relied  on  to  solve 
most  of  them.  They  must  utilize  to  the  utmost  the  ar- 
ticles of  the  ration,  and  such  other  good  food-supplies 
^as  they  can  obtain,  and  the  equipment  furnished  for 
cooking  and  such  additions  to  it  as  they  have  or  can 
prepare ;  and  must  put  to  use  or  minimize  the  harm  of 
natural  factors,  such  as  wind,  rain,  snow,  or  poor  fuel. 
It  is  the  ability  to  do  this  last  that  enables  some  men 
who  are  not  very  good  cooks  in  garrison  to  excel  in  the 
field.  While  a  man  knowing  more  of  cookery  may  let  a 
meal  be  spoiled  or  uncooked  because  of  poor  fuel,  rain, 
and  adverse  winds,  another  man  may  have  an  excellent 
fire  and  a  well-cooked  meal  in  spite  of  all  three.  Camp 
craft  results  from  experience  and  ingenuity,  and  the 
one  should  be  furnished  by  manoeuvre-camps  and  prac- 
tice-marches, and  the  other  encouraged  by  observant 
company  commanders  when  it  manifests  itself.  The 
man  possessing  these  qualities  will  gut  the  most  from 


88    THE   RECRUIT  AND  HIS   ENVIRONMENT 

his  utensils  and  his  fire,  whether  he  has  a  fully  equipped 
camp-stove,  a  spider  and  pots,  or  merely  a  trench  of 
his  own  digging. 

As  far  as  possible,  men  coming  in  from  a  march  or 
a  guard  should  be  supplied  with  hot  food  at  once,  and 
when  camp  is  changed  an  effort  should  be  made  to 
supply  a  hot  meal  as  soon  as  the  regular  meal-time 
comes.  This  means  the  use  of  kitchen  carts  or  fireless 
cookers,  or  the  early  establishment  of  the  kitchen  and 
the  use  of  food  that  can  be  quickly  cooked. 

As  in  garrison  so  in  camp,  cleanliness  of  cooks, 
kitchen,  and  food  are  secondary  only  to  the  actual  sup- 
ply of  food,  and  the  lack  of  it  will  do  more  harm  than 
partial  starvation.  Flies  have  greater  opportunities  to 
breed  in  camps  than  in  garrison,  dust  is  more  abun- 
dant and  blows  about  more  freely,  fecal  contamination 
of  hands,  shoes,  and  clothing  occurs  more  readily,  and 
the  facilities  for  storing  food  so  as  to  protect  it  from  all 
these  are  poorer.  Consequently,  the  amount  of  care  to 
be  exercised  is  greater,  and  the  necessity  for  minute  and 
thorough  cleanliness  more  urgent.  The  hands,  persons, 
and  clothing  of  the  cooks  and  assistants  should  receive 
the  greatest  care.  Tables,  benches,  blocks,  cooking 
utensils,  and  everything  about  the  kitchen  should  be 
cleaned  as  soon  as  used,  and  scalded,  if  it  be  possible, 
with  boiling  water.  Boxes  and  bags  containing  food 
should  be  frequently  inspected  inside  and  out,  and  their 
positions  shifted,  in  order  that  insects  may  not  gather 
in  or  about  them.  They  should  always  be  kept  clean. 
Kitchen  floors  and  surroundings  should  be  raked,  swept, 
or  scrubbed  after  each  meal,  so  that  all  particles  of  food 
and  everything  that  might  attract  flies  will  be  removed. 
Slop-buckets  and  garbage-cans  should  be  washed  after 


CAMPS  89 

each  emptying,  and  not  allowed  to  become  crusted  with 
a  greasy  coat  of  filth.  At  least  once  a  day  a  rigid  in- 
spection of  the  kitchen  should  be  made  and  all  points 
of  kitchen  police  investigated.  Reliable  men  should  be 
put  on  this  duty  and  rewarded  for  its  proper  perform- 
ance. Mosquito  netting  or  wire-gauze  covers  should 
be  provided  for  the  protection  of  food  while  it  is  await- 
ing preparation  or  serving.  Sheeting  or  boxes  should 
protect  it  from  dust. 

It  is  questionable  whether  screening  the  entire  kitchen 
is  always  advisable.  Cleanliness  is  necessary  in  keeping 
down  flies,  and  if  a  kitchen  is  screened  all  around  it  is 
darker  and  has  more  angles  and  corners  in  which  dirt 
and  scraps  may  collect  to  attract  them.  As  the  door  is 
of  necessity  frequently  opened,  they  enter  and  are  then 
kept  in  by  the  screening.  Screening  is  an  aid  in  pre- 
serving the  food  uncontaminated,  but  it  does  not  justify 
even  the  partial  neglect  of  the  more  important  matter 
of  scrupulous  cleanliness. 

The  kitchen  fire  should  constitute  a  small  crematory 
for  kitchen-waste,  and  the  cook  should  endeavor  to  be 
as  independent  as  he  can  of  civilian  scavengers  and 
fatigue  parties.  Nearly  all  scraps  and  solid  waste  that 
are  to  be  thrown  away  can  be  burned  by  him,  and  at 
times  he  can  take  care  of  most  or  all  of  his  dirty  water 
by  devices  to  be  described  later.  Every  tin  can  that  is 
emptied  should  be  thrown  into  the  fire  and  all  organic 
matter  in  or  on  it  destroj'ed.  Later  it  may  be  hauled 
away  or  bui-ied. 

Major  II.  A.  Arnold  has  described  the  following  ar- 
rangement  as  working  satisfactorily  in  the  Pennsylvania 
militia.  A  pit  is  dug  about  60  inches  long,  30  inches 
wide,  48  inches  deep  at  one  end,  and  36  inches  deep  at 


90    THE   RECRUIT  AND  HIS  ENVIRONMENT 

the  other.  It  is  filled  loosely  with  stones  to  a  height  a 
few  inches  above  the  general  ground-level,  and  is  banked 
on  all  sides  to  protect  it  from  surface-water.  The  kitchen 
fire  is  built  on  these  stones,  and  is  inclosed  on  the  sides, 
but  the  ends  of  the  trough  thus  made  are  left  open.  All 
watery  material,  such  as  waste  coffee  and  dish-water,  is 
poured  on  the  stones  at  the  shallow  end  of  the  pit.  The 
heat  of  the  stones  evaporates  it.  All  solid  waste,  includ- 
ing tin  cans,  is  burned  in  the  fire.  The  ashes  and  d(ibris 
are  removed  as  necessary.  It  is  thought  that  this  might 
be  somewhat  improved  by  having  the  liquid  waste  first 
strained  by  passing  it  through  a  layer  of  straw  or  ex- 
celsior six  inches  deep,  which  would  catch  much  of  the 
fine  solids  and  grease  in  it.  The  straw  should  then  be 
burned  and  fresh  supplied  once  or  twice  daily.  It  might 
be  placed  in  the  bottom  of  a  large  tin  or  other  box,  or 
in  a  shallow  pit  that  drained  into  the  larger  one.  At 
other  times,  when  the  particular  conditions  would  war- 
rant it,  the  water  could  be  led  away  to  a  stream  by  such 
a  filled  trench  as  was  described  for  the  bath-water, 
provided  it  were  first  strained  through  straw.  Otherwise 
the  trench  would  soon  become  foul  with  a  deposit  of 
soap,  grease,  and  food-particles.  When  garbage  and 
waste  water  are  hauled  away  for  disposal  elsewhere,  the 
matter  of  emptying  them  from  cans  and  loading  them 
into  wagons  should  be  carefully  done  under  the  super- 
vision of  a  responsible  man,  with  a  view  to  the  preven- 
tion of  spilling  and  the  immediate  cleaning  up  of  any 
that  may  occur.  Receptacles  should  be  washed  inside 
and  out  immediately  after  emptying,  and  should  at  all 
other  times  be  kept  tightly  covered.  Lime-washing  the 
cans  and  the  stands  on  which  they  rest  renders  the 
detection  of  dirt  easier  and  is  therefore  recommended. 


CAMPS  91 

If  abundance  of  good  food  is  provided  in  the  messes, 
the  men  have  no  proper  excuse  for  indulging  in  im- 
proper food  obtained  from  peddlers,  and  such  persons 
should  be  excluded  from  the  camp  and  its  environs. 

Papers,  sweepings,  and  other  ordinary  camp  litter,  as 
well  as  horse-manure  and  stable-dirt,  should  be  burned, 
and  such  disposal  of  it  is  easy  and  conven- 
lent.  If  not  so  disposed  of,  it  is  apt  to  become  ^ 

scattered,  create  a  nuisance,  and,  particu- 
larly, to  do  harm  as  affording  breeding- 
places  for  flies.  A  crematory  may  readily  be  impro- 
vised, and  if  a  good  draught  is  furnished,  it  may  be 
kept  burning  continually  with  waste  as  fuel.  Three 
forms  of  pit  or  crematory  are  as  follows,  and  any  one 
of  them  may  be  easily  and  quickly  constructed :  — 

1.  A  cylinder  of  about  the  height  and  capacity  of  a 
barrel,  built  of  blocks  of  sod  about  a  foot  square.  It 
may  be  steadied  by  having  posts  planted  on  two  or  three 
sides  of  it,  and  being  wrapped  with  wire.  An  air-inlet 
about  ten  inches  square  should  be  left  at  the  bottom, 
and  if  iron  piping  or  rods  are  available  a  grate  may  be 
made  of  them. 

2.  A  circular  pit  with  a  cone  of  stones,  around 
which  the  fire  is  built,  piled  up  in  the  middle. 

3.  A  horseshoe-shaped  mound  of  earth,  or  a  niche 
dug  in  a  bank,  or  a  trench  open  at  one  end. 

Other  forms  may  be  improvised  to  suit  conditions, 
and  bits  of  stove-pipe  or  other  means  of  improving 
the  draft  or  protecting  the  fire  from  rain  can  be  util- 
ized. These  pits  must  be  cleaned  as  necessary,  and  the 
ashes  and  unconsumed  matters,  such  as  tin  cans,  placed 
where  they  cannot  constitute  a  nuisance. 

The  proper  disposal  of  the  products  of  human  waste, 


92     THE   RECRUIT  AND   HIS   ENVIRONMENT 

feces  and  urine,  so  that  they  may  not  create  a  nuisance 

_  or  constitute  a  source  of  danerer,  is  one  of 

Feces  • 

J  __  .         the    most    important   problems    of   camp 

sanitation.  The  nearest  approach  to  its  so- 
lution that  has  ever  been  made  is  their  incineration,  and 
the  difficulties  in  the  way  of  that,  except  in  camps  of 
some  permanency  and  at  considerable  cost,  are  so  great 
as  to  be  in  most  instances  insurmountable.  In  our  ma- 
noeuvre camps  and  permanent  camps  the  Mc  Call  incin- 
erator has  proven  a  great  boon,  but  whether  it  will 
prove  as  valuable  and  as  workable  when  used  by  troops 
that  move  frequently  is  doubtful.  Even  as  used  now, 
though,  it  is  of  great  value  and  justifies  the  rather 
large  expenditure  it  necessitates.  Care  in  its  manage- 
ment is  necessary  to  keep  down  unpleasant  odors,  and 
repairs  must  be  made  promptly,  as  the  need  for  them 
arises,  or  the  whole  apparatus  may  get  out  of  order 
and  cease  to  operate  satisfactoi'ily.  A  competent  and 
intelligent  man  should  have  supervision  of  each  one, 
should  be  familiar  with  its  construction  and  the  man- 
ner of  operating  it,  and  should  see  that  it  is  operated 
properly  and  in  accordance  with  directions.  In  some 
of  our  manoeuvre  camps  it  has  been  possible  to  install 
inexpensive  but  satisfactory  systems  of  water-carriage 
latrines  that  empty  into  the  sea  or  other  safe  place. 
Such  a  system  consists  of  a  long  iron  or  zinc  trough, 
much  like  the  Reed  trough,  sloping  from  its  upper  end, 
where  water  enters  it,  to  its  lower,  where  is  an  outlet 
which  is  closed  by  a  cylinder  that  screws  into  threads  in 
it  and  fits  tightly.  The  water-supply  is  from  a  faucet, 
and  may  also  be  from  a  water-flushed  urine  trough  that 
empties  into  the  upper  end  of  the  main  or  large  trough, 
above  which  is  a  long  board  with  seat  openings,  which 


CAMPS  93 

may  or  may  not  have  hinged  covers.  The  whole  plant 
is  housed  in  a  cheap  but  clean  shed.  The  trough  is 
filled  with  water,  into  which  the  feces  and  paper  drop, 
and  is  flushed  by  gravity  when  the  care-taker  removes 
the  cylinder  that  is  screwed  into  the  outlet,  the  entire 
contents  then  flowing  into  the  drain  of  glazed  earthen 
pipes  that  lead  it  away.  Such  a  system  is  open  to  the 
objection  that  it  applies  only  to  fixed  camps. 

The  Reed  trough,,  pumj),  and  wagon  as  described  in 
G.  O.  170,  A.  G.  O.,  1899,  offer  another  fair  method 
of  disposal  of  excreta,  inferior  to  those  discussed  above 
where  they  are  applicable,  and  so  cumbrous  as  not  to 
be  available  except  in  camps  of  some  permanency. 

The  methods  of  disposal  actually  used  in  short  camps, 
or  by  troops  that  change  positions  at  all  frequently,  are 
the  use  of  deep  trench  latrines,  of  shallow  trenches, 
and  of  no  trenches,  but  rather  a  disregard  of  the  sub- 
ject. All  of  these  are  filthy,  dangerous,  and  objection- 
able. They  are  apt  to  constitute  disgusting  nuisances 
to  the  eyes  and  nose,  dangerous  sources  of  fecal  contam- 
ination of  shoes  and  clothing,  sources  of  camp-pollution 
by  seepage  and  leakage,  and,  worst  of  all,  vile  and 
dangerous  breeding-places  for  flies  that  carry  contami- 
nation from  them  to  the  food  or  persons  of  the  men. 
These  objectionable  features  may  be  lessened  by  proper 
care,  and  it  is  most  reprehensible  to  neglect  it. 

The  deep  trench  is  probably  most  generally  used  by 
our  troops  in  camp,  and  is  prescribed  in  Field  Service 
Regulations.  A  trench  two  and  a  half  feet  wide,  six  feet 
deep,  and  of  varying  length,  is  dug,  a  seat  is  provided 
by  means  of  a  small  log  or  piece  of  timber  supported 
on  forked  or  crossed  pieces,  and  the  whole  more  or 
less  protected  from  sight  by  a  brush  screen.    The  care 


94    THE  RECRUIT  AND  HIS  ENVIRONMENT 

exercised  varies  from  the  occasional  perfunctory  cov- 
ering of  feces  with  earth  to  the  abundant  use  of  lime 
and  the  daily  burning  out  of  the  whole  pit  w  ith  crude 
petroleum.  Whatever  measures  are  used,  they  are 
usually  insufficient  to  keep  down  odor  and  flies  in  hot 
weather.  The  best  results  are  probably  to  be  attained 
by  having  a  man  stationed  at  the  pit,  whose  business 
it  is  to  keep  all  fecal  matter  and  soiled  paper  covered 
with  loose,  dry  earth  at  all  times.  The  ground  about  the 
pits  should  be  kept  thoroughly  policed  and  protected 
from  contamination  with  feces  and  urine.  If  crude  oil 
is  available,  it  may  be  advantageously  sprinkled  into 
the  pit  daily,  as  an  aid  in  keeping  away  flies  or  destroy- 
ing their  larvae,  and  for  the  latter  purpose  its  use 
should  be  rather  lavish.  The  whole  pit  should  be  pro- 
tected from  surface-washings  by  ditching  and  embank- 
ments, and  from  rainfall  by  a  tent-fly.  No  more  dis- 
gusting sight  can  be  imagined  than  that  afforded  by 
such  a  pit  partly  full  of  feces,  alive  with  maggots,  and 
flooded  by  tropical  rains. 

When  flies  begin  to  breed  in  a  pit,  and  the  larvae 
cannot  be  destroyed  by  oil  or  otherwise,  it  should  be 
filled  and  another  dug.  Burning  the  pits  out  daily  with 
straw  and  crude  petroleum  ipay  aid  in  keeping  down 
flies,  but  as  often  practiced  it  will  not  entirely  do  away 
with  them  or  their  larvae.  Immediate  and  rather  deep 
covering  of  dejecta,  and  thorough  policing  of  the  pits 
and  their  surroundings,  are  the  most  efficient  means  of 
caring  for  them.  They  should  always  be  placed  as  far 
from  the  kitchens  as  is  practicable,  and  where  they  will 
do  a  minimum  of  damage  to  water-supplies.  Toilet-paper 
should  be  provided  and  kept  in  covered  boxes,  so  that 
it  may  not  be  blown  about  camp.   The  pits  should  be 


CAMPS  95 

inspected  at  frequent  intervals  by  an  officer,  who  will 
see  that  the  man  in  charge  is  doing  his  work  properly, 
that  flies  are  being  kept  down  as  thoroughly  as  possible, 
and  that  men  who  willfully  or  carelessly  pollute  the  sur- 
roundings with  urine  or  feces  are  punished.  It  is  always 
essential  that  a  separate  urine  pit  be  provided,  as  a 
proper  state  is  more  readily  maintained  in  the  feces 
pit  if  it  be  dry. 

Major  William  Jepson,  M.  D.,  I.  N.  G.,  devised  the 
arrangement  described  below,  and  it  was  put  in  success- 
ful use  in  the  encampment  of  the  56th  Iowa  in  July, 
1908.  The  quotation  is  from  a  report  by  Major  Daniel 
H.  Boughton,  U.  S.  A. 

"Near  each  kitchen  fire  a  hole  eight  or  nine  inches 
in  diameter  and  six  or  seven  feet  deep  was  dug  with  a 
post-hole  auger.  Into  the  mouth  of  this  hole  was  fitted 
a  bucket  with  a  wire  bottom  to  catch  solid  matter  as 
slops  were  poured  in,  the  top  being  flush  with  the  sur- 
face of  the  ground  and  provided  with  a  lid.  The  liquid 
matter  ran  through  into  these  post-holes,  and  the  solid 
matter  was  thrown  into  a  garbage-can  and  then  re- 
moved in  the  usual  manner  by  police  parties.  Instead 
of  a  bucket  specially  prepared  to  catch  solid  matter,  a 
piece  of  wire  netting  or  gunny  sack  could  be  used. 

"One  of  these  holes  sufficed  for  each  company  kitchen 
during  the  seven  days'  encampment.  The  ground  where 
this  method  was  used  consisted  of  about  three  feet  of 
black  loam  with  a  subsoil  of  clay,  the  most  difficult 
ground  in  wliich  to  dispose  of  liquid  waste ;  neverthe- 
less the  method  was  satisfactory.  Sand  or  gravelly  sub- 
soil is  better.  If  pits  are  dug  with  the  spade  they  should 
be  kept  covered  with  pieces  of  thin  muslin  or  other 
material. 


96    THE  RECRUIT  AND   HIS  ENVIRONMENT 

"  Latrines  were  prepared  by  digging  with  the  auger  a 
series  of  holes  at  the  proper  distance  apart,  and  also  by 
digrs'insr  trenches  in  the  usual  manner.  Over  these  holes 
or  trenches  boards  with  the  necessary  openings  were 
placed  at  the  proper  height,  and  thin  muslin  was  tacked 
to  the  edges,  and  stretched  to  the  ground,  where  it  was 
pinned  with  small  wooden  pegs  ;  covers  for  the  openings 
were  also  provided,  making  the  pits  absolutely  fly- 
proof.  These  covers  in  some  cases  were  made  of  tin, 
and  in  others  of  thin  muslin  to  which  a  piece  of  wood 
was  tacked  to  hold  it  over  the  opening  when  not  in  use. 
Urinals  were  made  by  taking  pieces  of  the  same  cloth 
coated  with  gas  tar  and  suspending  them  in  the  form 
of  troughs  in  rear  of  the  latrine  seats.  Each  trough 
communicated  with  the  trench  by  a  pipe  made  of  the 
same  material  as  the  trough. 

"The  latrines  were  screened  from  view  but  left  open 
at  the  top,  and  though  the  deposits  were  not  covered 
nor  disinfectants  used,  the  odor  was  scarcely  distinguish- 
able a  few  feet  away.  It  was  constantly  escaping  into 
the  air.  Latrines  of  this  nature  can  be  readily  con- 
structed by  troops  and  at  very  little  cost.  The  secret  is 
in  keeping  out  the  flies.  As  the  deposits  were  not 
covered  with  earth  or  ashes,  a  single  trench  accommo- 
dating six  seats  was  sufficient  for  a  battalion  of  over 
200  men  during  the  entire  week." 

The  shallow  trench  system  "is  prescribed  by  Field 
Service  Regulations  for  camps  of  one  night  only,  but  it 
has  found  more  general  use  in  the  British  Service,  and 
the  following  advantages  are  claimed :  1st,  That  the 
walls  do  not  have  time  to  become  foul,  and  the  odor 
arising  is  very  much  less  than  from  deep  trenches.  2d, 
That  flies  are  much  less  numerous  about  them.  3d,  That 


CAMPS  97 

the  feces  become  speedily  transformed  into  simpler 
matters,  so  that  no  signs  of  fecal  matter  as  such  re- 
main after  three  or  four  weeks.  4th,  That  disease- 
producing  organisms  are  more  quickly  destroyed.  As 
used  during  the  manoeuvres  in  Hampshire  in  1907,  the 
system  was  as  follows,  and  was  said  to  give  excellent 
results.  The  trenches  were  dug  one  foot  deep,  one  foot 
wide,  and  three  feet  long,  and  were  arranged  in  lines  two 
and  a  half  feet  apart.  If  ground  was  scarce  they  were 
made  two  feet  deep.  Enough  trenches  were  dug  to 
accommodate  jive  per  cent  of  the  command.  The  turf 
was  carefully  removed  and  laid  aside,  the  dirt  taken  out 
was  pulverized.  A  man  was  at  all  times  detailed  in 
charge  of  the  pits,  to  see  that  each  soldier  thoroughly 
covered  his  own  deposits  with  pulverized  earth,  for  which 
purpose  cans  or  shovels  were  provided.  The  trenches 
were  usually  found  to  last  two  days,  when  they  were 
"carefully  and  solidly  filled  and  the  turf  replaced,  new 
trenches  being  dug  in  the  interspaces.  The  same  pre- 
cautions as  to  dryness,  blowing  paper,  complete  covering 
of  excreta,  separate  urinals,  and  general  police  have  to 
be  observed  as  when  deep  pits  are  used. 

The  dry  earth  and  pail  systems  do  not  need  discus- 
sion, as  they  are  not  satisfactory  for  use  in  camps,  and 
where  conditions  are  such  as  to  permit  of  their  installa- 
tion they  will  also  permit  of  the  use  of  McCall  incin- 
erators or  Reed  troughs,  both  superior  to  them. 

As  stated  above,  urinals  should  be  provided  separately 
for  the  use  of  men  not  desiring  to  defecate  at  the  same 
time.  The  McCall  incinerator  and  the  Reed  . 

trough  system  both  make  such  provision, 
but  when  pits  or  trenches  are  used,  it  is  frequently 
neglected.    The  provision  should  be  for  both  night  and 


98    THE  RECRUIT  AND  HIS   ENVIRONMENT 

day.  NigM  urinals  consist  of  large  cans  or  half -barrels, 
to  be  placed  in  the  company  streets  at  night,  and  to  be 
carried  away  and  emptied  and  washed  in  the  morning. 
If  one  emptying  does  not  suffice  to  prevent  overflow  or 
spilling,  they  should  be  emptied*  also  at  ten  o'clock  at 
night.  They  should  be  marked  at  night  with  lanterns, 
so  that  they  may  be  easily  located.  During  the  day, 
when  not  in  use,  they  should  be  kept  clean  and  dry  and 
exposed  to  the  sun.  The  day  urinal  may  be  similar,  or 
it  may  be  a  trench,  pit,  or  box.  A  circular  pit  may  be 
dug,  two  feet  in  diameter  and  three  feet  deep,  and  filled 
with  stones,  clinkers,  or  sawdust,  and  the  men  allowed 
to  urinate  into  it ;  or  a  barrel  or  box  with  both  ends 
knocked  out  may  be  half-buried  and  similarly  filled.  If 
pine-needles  or  sawdust  are  available,  they  should  be 
used  for  the  filling,  as  they  are  credited  with  great  virtue 
in  preventing  the  development  of  bad  odor.  Shallow 
trenches,  leading  to  pits  filled  with  coarse  rocks,  may  be' 
used,  and,  as  they  become  foul,  filled,  and  new  ones 
dug,  until  the  pit  itself  is  foul  or  the  entire  surface 
about  it  has  been  utilized  for  trenches.  The  Jepson 
urinal  has  been  described. 

While  urine  pits  or  trenches  do  not  afford  the  fly- 
breeding  facilities  of  fecal  accumulations,  they  do  pre- 
sent opportunities  for  the  spread  of  typhoid  infection, 
and  care  should  be  exercised  to  prevent  dust  or  mud 
from  them  being  carried  to  camp  by  the  wind  or  on 
men's  shoes,  and  particularly  to  prevent  the  pollution 
of  water-supplies  from  them.  Urine  is  more  manageable 
than  feces  because  of  its  fluidity,  and,  if  necessary,  it 
can  be  chemically  disinfected  in  the  barrels  or  cans,  by 
the  use  of  bichloride,  carbolic,  or  formalin. 

There  is  a  tendency  to  look  upon  the  matter  of  camp 


CAMPS  99 

policing  as  an  affair  of  military  discipline  rather  than 

of  great  sanitary  importance,  and  for  that 

reason  it    is    strongly  recommended    that     _       '^ 
•  FolicG 

whenever  it  is  possible  a   medical   officer 

should  be  made  police  officer.  He  understands  better 
than  the  line  officer  the  sanitary  dangers  of  the  camp, 
while  his  interest  in  having  it  present  a  neat  and  mili- 
tary appearance  is  quite  as  great.  He  is  more  interested 
than  any  one  else  in  having  a  small  sick  report,  and  he 
alone,  in  most  instances,  finds  interest  and  profit  in  the 
study  and  prevention  of  vermin  and  pests,  in  the  dis- 
posal of  excreta,  and  in  studying  the  tastes  and  history 
of  the  fly  and  the  mosquito.  He  should  have  at  his  dis- 
posal a  sanitary  squad  under  a  sanitary  sergeant,  such  a 
squad  consisting  of  at  least  one  man  from  each  company 
and  one  noncommissioned  officer  of  the  hospital  corps. 
In  addition  to  that,  the  provost  sergeant  and  fatigue  par- 
ties should  report  to  him,  rather  than  to  the  quarter- 
master, for  instructions  regarding  all  work  having  a 
sanitary  bearing.  He  should  be  responsible  for  sanitary 
conditions,  but  he  should  have,  with  responsibility,  a 
proper  authority  and  proper  freedom  of  action.  The 
camp  police  will,  at  times,  necessarily  extend  beyond  the 
camp  proper.  It  may  embrace  the  improvement  or  pro- 
tection of  the  water-supply,  the  draining  of  a  swamp, 
the  petrolizing  of  pools,  the  clearing  of  brush  quite 
outside  of  the  camp  limits.  Under  certain  conditions 
it  may  include  a  quarantine  system,  a  war  on  rats,  a 
house-to-house  inspection  of  civilians,  the  suppression 
or  regulation  of  traffic,  as  that  in  milk,  green  vegeta- 
bles, or  other  foods.  In  all  these  matters  the  medical 
officer  should  have  as  free  a  hand  as  possible,  and  should 
be  able  to  carry  out  his  own  recommendations  under  no 


100    THE   RECRUIT  AND  HIS  ENVIRONMENT 

other  control  than  that  of  the  commanding  officer.  It 
is  confidently  believed  that  such  an  arrangement  as  is 
here  advocated  would  make  for  greater  efficiency  and 
quicker  and  better  accomplishment  of  sanitary  mea- 
sures, without  in  any  way  causing  discord  or  impairing 
the  value  or  dignity  of  the  services  of  other  persons. 


THE  SEHVios-  .-^(-1 

BOSTOM 


CHAPTER  VI 

THE   HYGIENE   OF  MOVING   TROOPS 

The  march,  the  battlefield,  changes  by  ship  and  rail, 
all  present  their  special  problems  of  sanitation,  neglect 
of  which  may  result  in  disaster  to  the  careless  command 
or  to  its  friends  and  allies.  Many  men  and  some  offi- 
cers are  apt  to  ignore  the  latter  phase  of  the  question 
and  to  think  that  when  they  have  avoided  harm  to 
themselves  and  their  companies  they  have  performed 
their  full  duty  in  sanitary  matters.  Nowhere  is  a  man 
his  brother's  keeper  to  a  greater  degree  than  in  an 
army,  and  it  is  hoped  that  the  fact  may  become  more 
fully  appreciated. 

Article  V  of  the  Field  Service  Regulations  deals  well 
with  the  subject  of  marches ;  but  the  rules  there  given 
should  be  applied  with  discretion.  It  must  ,, 
be  remembered  that  the  various  possible 
states  of  weather,  roads,  and  personnel  may  result  in 
an  almost  infinite  variety  of  circumstances,  all  of 
which  could  not  possibly  be  considered  in  any  set  of 
printed  rules.  Much  must  depend  on  the  judgment 
of  the  commanding  officer,  in  sanitary  as  in  tactical 
matters,  and  his  knowledge  or  lack  of  knowledge  of 
sanitation  may  determine  the  success  or  failure  of  a 
movement.  If  good  judgment  is  used  in  adapting  the 
regulations  to  the  circumstances,  the  rules  laid  down 
therein  will  constitute  a  reliable  general  guide.  The 
length  and  speed  of  the  march,  for  instance,  must  be 
materially  influenced  by  climate,  weather,  roads,  water, 


102    THE  RECRUIT  AND  HIS  ENVIRONMENT 

transportation,  weight  carried,  amount  and  character 
of  sickness  in  the  command,  the  rations,  character 
and  state  of  the  clothing,  the  spirits  of  the  command, 
the  objective,  temperance  in  the  use  of  intoxicants,  and 
other  factors. 

The  length  and  frequency  of  rests  must  be  influenced 
by  much  the  same  factors,  and  the  commander  who 
sets  a  pace  and  determines  the  frequency  and  duration 
of  rests  without  regard  to  these  influences  is  not  doing 
justice  to  his  men.  The  time  of  day  during  which  the 
march  is  to  be  made  will  also  influence  the  length, 
speed,  and  rests,  and  the  choice  of  it  must  in  turn  be 
influenced  by  diverse  considerations.  Thus  the  temper- 
ature may  make  daytime  marching  very  trying,  yet 
the  state  of  the  roads,  the  possibility  of  malarial  or 
other  infections,  the  presence  of  sick,  and  other  consid- 
erations, may  make  it  appear  the  lesser  of  evils.  It  is 
always  well,  therefore,  to  consider  these  various  influ- 
ences and  to  bear  in  mind  that  the  command  brought 
into  camp  in  good  spirits  and  good  condition  after 
what  may  be  a  relatively  short  march,  is  in  better  con- 
dition for  large  accomplishments  on  the  morrow,  than 
another  command  that  has  marched  five  miles  farther, 
but  has  reached  camp  with  the  men  footsore,  weary, 
discouraged,  and  with  their  vital  resistance  so  lowered 
as  to  be  ready  to  yield  to  the  inroads  of  any  chance 
infection.  The  influence  of  climate  and  weather  is  so 
quickly  manifested  on  the  men,  and  in  such  obvious 
and  well-known  ways,  as  not  to  need  much  discussion, 
and  a  moderate  amount  of  common  sense  and  consider- 
ation for  his  men  should  cause  an  oflicer  to  make  allow- 
ances for  them.  Heat,  wind,  snow,  rain,  fog,  slush, 
glare,   mugginess,  all  tire,   discourage,   and   tend   to 


THE   HYGIENE   OF  MOVING  TROOPS     103 

sicken  the  men,  shorten  the  march,  and  increase  the 
rests. 

Closely  related  to  these  is  the  state  of  the  roads. 
Mud,  excessive  dust,  loose  sand  or  gravel,  very  rough 
and  uneven  roads,  all  increase  delay,  vexation,  and 
fatigue,  and,  even  when  weather  conditions  are  good, 
may  cut  the  march  to  a  fraction  of  what  is  desired. 
Not  to  be  separated  from  the  question  of  roads  is  that 
of  transportation.  If  the  former  are  good,  abundant 
wagon  transportation  may  be  used,  if  available,  lessen- 
ing the  loads  of  the  men,  supplying  them  with  abundant 
food,  tentage,  and  other  necessities  and  comforts.  If 
they  are  bad,  transportation  facilities  may  be  much 
limited  in  consequence,  or,  if  furnished,  may  prove  a 
source  of  vexation  and  weariness,  the  men  having  to 
spend  hours  of  toil  extricating  mired  animals  or  wag- 
ons, in  unloading,  loading,  and  carrying  freight.  Such 
trials  of  body  and  spirit  react  on  the  health,  and  when, 
in  addition,  because  of  failure  of  the  transport  wagons, 
men  have  to  lie  down  supperless  and  without  proper 
shelter,  the  question  of  transportation  has  assumed  a 
sanitary  importance  of  magnitude. 

Intimately  related  to  the  question  of  transportation 
is  that  of  the  v;eig]it  carried  by  the  men,  and  the  at- 
tempt is  wisely  made  to  reduce  this  to  a  minimum ; 
yet  under  some  conditions,  and  generally  they  are  those 
in  which  men  should  have  to  carry  the  least,  as  in  bad 
weather,  over  bad  roads,  on  forced  marches,  after  very 
trying  campaigns  that  sicken  man  and  beast,  trans- 
portation may  fail  and  the  men  have  to  carry  extra 
ammunition,  food,  and  clothing.  If  this  is  a  necessity 
the  best  should  be  made  of  it  and  the  load  carried, 
but  the  march  should,  as  far  as  possible,  be  regulated 


104    THE  RECRUIT  AND    HIS   ENVIRONMENT 

to  suit  the  altered  conditions.  We  are  not  able  to  breed 
or  buy  men  as  we  do  horses,  with  a  view  to  their 
strength,  speed,  endurance,  or  spirit,  though  we  do 
attempt  to  select  them  with  a  view  to  these  qualities. 
Nevertheless,  each  organization  will  have  its  strong  and 
its  weak  men,  its  fast  and  its  slow,  its  cheerful  and 
its  despondent,  and  it  is  the  less  desirable  of  these  that 
must  be  most  considered  under  trying  conditions.  The 
weak  man  must  not  be  overloaded,  the  lame  man  over- 
marched,  because  the  more  able  men  can  march  far- 
ther or  carry  more.  Otherwise  they  will  become  sick, 
and  the  problem  is  worse  complicated  than  before. 
Disregard  of  this  simple  fact  has  been  known  to  re- 
sult in  most  serious  consequences.  Whatever  the 
weight  carried,  it  should  be  so  disposed  on  the  person 
as  to  carry  as  comfortably  as  possible,  and  not  constrict 
or  compress  the  chest.  As  stated  before,  it  is  on  the 
free  play  and  efficient  working  of  the  heart  and  lungs 
that  strength  and  endurance  depend.  If  the  chest  is 
compressed  and  its  mobility  lessened  by  tight  clothing, 
crossed  straps,  or  other  cause,  that  free  and  efficient 
working  are  impossible,  and  the  man  becomes  exhausted 
under  a  load  that  might  not  greatly  inconvenience  him 
if  more  wisely  disposed.  Recent  experiments  have  de- 
monstrated that  inhalations  of  oxygen  enable  athletes 
to  run  farther  and  faster,  and  with  less  inconvenience, 
than  is  the  case  without  such  inhalations.  When  the 
action  of  either  the  lungs  or  heart  is  interfered  with, 
the  oxygenation  of  the  blood  is  hindered  and  early 
tiring,  weakness,  and  exhaustion  follow.  These  con- 
ditions constitute  not  only  disturbing  and  delaying 
factors  of  a  temporary  nature,  but  also  weaken  the  re- 
sistance to  disease  and  prepare  the  way  for  infections. 


THE  HYGIENE  OF   MOVING  TROOPS     105 

Sickness  in  the  command  that  is  moving  always 
occasions  delay,  often  very  much  extra  work,  and,  quite 
as  often,  danger  of  epidemics.  All  sick  should  there- 
fore be  left  behind,  if  possible,  when  the  march  begins ; 
all  hygienic  measures  should  be  employed  to  prevent 
other  men  becoming  sick ;  all  who  do  become  so  should 
report  to  the  medical  officer  as  soon  as  practicable  so 
as  to  get  the  benefit  of  early  observation,  treatment, 
and  care,  and  all  who  do  not  favorably  and  quickly  re- 
spond to  such  early  care  should,  if  possible,  be  provided 
for  on  the  way,  in  houses,  camps,  or  hospitals,  or  sent 
back,  and  not  allowed  to  hamper  and  constitute  a  dan- 
ger to  the  entire  command.  The  Field  Service  Regu- 
lations prescribe  that  the  sick  shall  be  eliminated  before 
the  start  is  made,  but  in  practice  certain  classes  of 
sick  are  not  eliminated  and  later  give  much  trouble. 
Among  these  are  venereal  cases.  Many  such  do  not 
appear  on  sick  report  unless  frequent  inspections  are 
made  and  they  are  ordered  to  report.  These  men.  though 
doing  full  garrison  duty  and  feeling  well,  are  likely  to 
develop  buboes  on  the  march  and  be  unfitted  for  either 
walking  or  horseback  riding. 

Men  recently  discharged  from  treatment  in  hospital 
for  malaria,  dysentery,  and  other  debilitating  diseases 
are  apt  to  become  exhausted  or  to  have  recurrences  of 
their  sickness  when  subjected  to  hard  marches. 

Weak  hearts  and  weak  feet  are  liable  to  break  down 
under  similar  conditions,  and  men  known  to  suffer  from 
either  should  be  excluded.  Not  only  should  sick  men 
be  excluded  from  the  march,  but  well  men  should  be 
taught  and,  if  necessary,  compelled,  to  conduct  them- 
selves in  such  a  way  as  to  maintain  their  efficiency  and 
strength.    Alcoholism,  particularly,  should  be  discour- 


106    THE  RECRUIT  AND  HIS  ENVIRONMENT 

aged,  and  all  straggling  to  get  alcohol  and  all  drinking 
in  ranks  should  be  punished ;  for  not  only  does  the  in- 
dulgence lead  to  inefficiency  from  drunkenness,  but  it 
predisposes  to  exhaustion,  infections,  injuries,  to  heat- 
stroke in  hot  weather  and  freezing  in  cold.  While  not 
useful  nor  to  be  encouraged  in  camp,  drinking,  if  not 
carried  to  excess  and  not  prolonged  into  the  hours  be- 
longing to  sleep,  is  then  less  directly  harmful  than  on 
the  march. 

Cheerfulness  and  hright  hopes  are  powerful  stimu- 
lants to  accomplishment,  and  it  should  be  the  aim  of 
the  company  commander  to  keep  his  men  in  such  a 
state  of  mind.  Difficulties  may  often  be  laughed  away, 
while  if  given  too  much  thought  or  gloomily  dwelt  upon 
they  readily  become  insurmountable.  One  of  the  great 
items  in  Napoleon's  success  was  his  faculty  of  having 
his  men  accomplish  the  impossible. 

Hardships  may  be  magnified  in  retrospect;  on  the 
march  they  should  be  minimized  and  belittled,  if  un- 
avoidable. 

Another  occasional  cause  of  exhaustion  is  said  to  be 

the  reckless  and  excessive  indulgence  in  water.   The 

Field  Service  Regulations  state  that  under 
"Vaster  •  • 

"ordinary  conditions  a  canteen  of   water 

should  last  a  man  a  day."  Ordinary  conditions  in  the 
field  are,  however,  hard  to  define,  and  the  amount  of 
water  needed  under  varying  conditions  and  by  differ- 
ent men  varies  greatly.  There  is  no  doubt  that  many 
men  do  use  water  injudiciously,  and  that,  by  training 
or  habit,  they  may  teach  themselves  such  moderation 
and  restraint  as  to  be  enabled  to  make  the  contents  of 
one  canteen  last  them  through  any  ordinary  day's 
march.    As  the  canteen  holds  two  and  one-half  pints 


THE  HYGIENE   OF   MOVING  TROOPS     107 

and  the  march  rarely  covers  more  than  eight  or  ten 
hours,  it  may  be  seen  that  this  should  not  involve  any 
hardship  for  a  well  and  fit  man.  It  is,  however,  a  well- 
recognized  fact  that  men  who  begin  a  march  with  the 
consumption  of  large  amounts  of  water,  and  who  early 
exhaust  their  canteens,  are  very  apt  to  become  ex- 
hausted or  to  fall  out  before  the  march  is  completed. 
The  consumption  of  the  water  is  not  always  the  sole 
cause  of  such  exhaustion,  but  both  may  be  the  effect  of 
a  common  cause,  such  as  sickness,  diarrhoea,  alcoholic 
indulgence,  excessive  smoking,  or  injudicious  eating  the 
night  before.  By  the  avoidance  of  such  indiscretions  the 
moderate  use  of  water  is  made  easy ;  but  if  a  man  has 
spent  a  part  of  the  night  in  alcoholic  indulgence,  smok- 
ing, and  eating  cheese  and  salt  herring,  his  system  is  so 
loaded  with  poisonous  waste-products  that  he  needs  a 
large  amount  of  water  to  dilute  and  remove  them,  and 
depriving  him  of  it  will  not  improve  his  condition  in 
any  way.  Aside  from  such  indiscretions,  more  water  is 
required  by  men  whose  food  is  very  salty  or  very  dry  ; 
by  those  marching  in  a  hot  sun  or  losing  much  water  in 
the  form  of  perspiration,  or  those  marching  in  dust,  as 
at  the  rear  of  a  column.  Thus  we  see  that  while  "ex- 
cessive "  use  of  water  is  harmful,  its  liberal  use  is  not. 
On  the  other  hand,  insufficiency  of  water  is  harmful, 
even  when  not  causing  suifering  through  thirst,  in  hot 
weather  as  predisposing  to  sunstroke,  and  as  causing 
such  concentration  of  the  urine  as  to  cause  very  severe 
bladder  irritation,  with  burning  and  pain  that  occasion 
great  suffering  and  alarm.  It  is  nevertheless  highly 
desirable  that  men  should  so  conduct  and  so  train 
themselves  that  they  can  be  able  to  get  through  the 
marching  hours  without  using  more  than  one  canteen- 


108     THE   RECRUIT   AND   HIS   ENVIRONMENT 

ful  of  water;  and  if  for  any  reason  they  cannot  do  so, 
it  is  usually  better  that  they  should  go  thirsty  than  that 
they  should  drink  water  from  unknown  sources  or  of 
doubtful  character,  as  a  few  hours  of  discomfort  from 
thirst,  or  an  attack  of  pain  in  the  bladder,  are  to  be 
preferred  to  an  attack  of  typhoid,  cholera,  dysentery,  or 
parasitic  infestation.  Sunstroke,  however,  may  be  as 
fatal  as  any  of  these,  and  if  symptoms  of  it  appear, 
water  must  be  used,  under  the  direction  of  the  surgeon, 
if  one  be  present. 

The  water  problem  should  be  handled  as  follows :  — 
Before  the  march  is  begun,  an  abundant  quantity  of 
good  water,  boiled  or  filtered  if  necessary,  should  be 
supplied.  If  the  water  is  boiled,  that  should  have  been 
done  the  night  before,  in  order  to  have  it  cool  in  the 
morning.  If  other  vessels  are  not  available,  it  may  be 
put  in  the  canteens  the  night  before  and  allowed  to  cool 
in  them.  Each  man  should  drink  what  he  wants  before 
starting,  using  his  cup  for  the  purpose,  and  have  his 
canteen  filled  from  the  good  supply.  Except  rarely,  he 
cannot  know  that  the  water  he  sees  later  in  the  day  will 
be  suitable  for  drinking,  and  he  should  therefore  drink 
then  only  from  his  canteen,  and,  in  order  that  it  may 
suffice,  exercise  great  care  and  moderation  in  his  use  of 
that  supply.  As  soon  as  camp  is  reached  in  the  evening, 
the  preparation  of  a  fresh  supply  should  be  begun,  and, 
if  boiling  is  the  form  of  purification  used,  the  first  drink 
furnished  may  be  tea  or  coffee.  Reckless  or  careless  in- 
dulgence in  water  from  supplies  of  unknown  character 
may  have  the  most  disastrous  results;  but  the  subject 
will  be  dealt  with  at  greater  length  in  a  subsequent 
chapter.  The  Field  Service  Regulations  say  that  "  a 
medical  officer  near  the  head  of  the  column  may  be  called 


THE   HYGIENE   OF   MOVING  TROOPS     109 

upon  to  decide  whether  water  is  fit  to  drink."  Again, 
let  it  be  remembered  that  he  can  only  base  his  opinion 
on  the  source  and  surroundings  of  the  supply  as  he  can 
see  them  or  learn  of  them  from  others.  The  appearance, 
odor,  taste,  and  such  other  tests  as  he  is  able  to  apply 
under  the  circumstances  can  in  no  wise  assure  bim  that 
the  "  water  is  fit  to  drink." 

In  the  paragraph  following  that  from  which  quota- 
tions have  been  made,  it  is  stated  that  "  good  oppor- 
tunities for  watering  (horses)  on  the  road  should  not 
be  neglected,  as  this  is  of  great  benefit  in  hot  weather 
and  on  severe  marches,*'  the  regulations  thus  recognizing 
in  the  horse  a  need  for  abundant  water  that  is  denied 
for  the  equally  hai'd-worked  animal,  man.  It  is  true, 
though,  that  the  horse  is  not  so  apt  to  suffer  from  dis- 
sipation and  to  need  the  relatively  large  amount  of  water 
required  by  the  dissipated  man.  It  is  sometimes  urged 
that  cold  weak  tea  or  coffee  be  carried  in  the  canteen  and 
drunk  on  the  march,  in  order  to  assure  the  use  of  boiled 
water.  Aside  from  the  possibility  of  their  being  diluted 
with  unboiled  water,  and  of  tea  being  made  with  cold 
and  unboiled  water,  these  drinks  are  not  so  refreshing 
and  thirst-satisfying  between  meals,  to  most  Americans, 
as  plain  water,  and  it  is  not  thought  that  they  are  as 
good  for  use  on  the  march  as  the  latter,  provided  that  it 
is  properly  purified  or  sterilized. 

The  food-supply  on  the  march,  as  elsewhere,  is  very 
important.  Because  of  the  greater  amount  of  work  per- 
formed, and  the  increased  tissue-chansres  „ 
due  to  the  outdoor  life,  the  amount  of  food 
required  on  the  march  exceeds  that  required  in  garrison ; 
while  because  of  the  few  and  imperfect  kitchen  facilities, 
the  new  and  strange  environment,  the  absence  of  water- 


110    THE  RECRUIT   AND  HIS   ENVIRONMENT 

closets,  and  for  other  reasons,  food  infection  is  more 
apt  to  occur,  and  every  effort  should  be  made  to  obtain 
cleanliness  and  to  serve  all  food  sterile,  rendered  so 
by  heat.  Because  of  the  exposure  to  which  the  men 
are  subjected,  diarrhoeal  troubles  are  readily  induced, 
and  irritating  foods  should  be  avoided.  Except  in  rare 
instances  it  should  be  possible  to  furnish  two  hot  and 
substantial  meals  a  day  to  the  marching  column,  and 
that  should  be  done.  A  hot  breakfast  should  be  served 
before  the  march  is  begun,  and  it  should  be  a  substan- 
tial meal,  such  as  one  of  meat,  potatoes,  bread,  and  coffee. 
Eggs  and  similar  articles,  if  obtainable,  may  be  used. 
The  noon  meal,  also,  should  be  prepared  and  issued  to 
the  men  before  starting,  and  should  embrace  much 
nutriment  in  relatively  small  bulk.  Fried  bacon,  cheese, 
sliced  meat,  and  bread  meet  the  requirements  well,  while 
a  pickle,  a  bit  of  fruit,  or  jam  adds  to  the  enjoyment 
of  it.  In  the  evening,  after  the  hard  work  of  the  march 
is  ended,  the  men  should  have  another  hot  meal,  and  as 
they  will  have  leisure  to  digest  it,  it  should  be  more 
bulky  than  the  other  meals.  Stews,  if  well  made,  answer 
admirably,  and  may  be  supplemented  with  such  addi- 
tions as  are  obtainable.  Because  of  lack  of  fuel,  delay 
in  the  arrival  of  company  wagons,  the  necessity  of  start- 
ing fires  and  doing  the  cooking  after  the  halt  is  made, 
the  evening  meal  is  often  late  ;  and  if  they  can  obtain 
other  food  many  men  eat  it,  often  with  little  regard  to 
its  suitability.  It  is  hoped  that  soup-carts,  ambulance 
kitchens,  and  fireless  cookers  will  correct  this  by  having 
a  ready  cooked  and  hot  meal  prepared  when  the  halt  is 
made.  Because  of  their  portability,  canned  and  pre- 
served foods  are  much  used  on  marches,  and  the  usual 
precautions  are  necessary  to  see  that  no  spoiled  cans  are 


THE   HYGIENE  OF  MOVING  TROOPS     111 

used.  If  this  be  done,  they  constitute  fairly  pleasant  and 
very  wholesome  food-supplies,  but  they  should  be  sup- 
plemented with  fresh  articles  when  these  are  obtainable. 
The  general  care  in  the  preparation  of  foods  that  has 
been  indicated  as  desirable  in  camps  should  be  exercised 
in  the  short  camps  made  by  marching  troops. 

The  government  provides  suitable  clothing  for  all 
varieties  of  climate  and  weather,  and  the  company  com- 
mander should  see  that  his  men  are  pro-  _,  ,  . 
vided  with  the  proper  kinds  and  amounts  to 
meet  the  probable  needs  of  the  march.  Flannel  shirts 
should  be  worn  even  in  tropical  climates,  as  they  pre- 
vent too  rapid  cooling  of  the  body  and  afford  protection 
from  the  night  chill.  Blouses  or  coats  are  rather  an 
impediment  than  a  help  in  the  tropics,  if  flannel  shirts 
are  worn.  The  poncho  should  always  be  carried  and 
the  blanket  nearly  always,  even  in  hot  seasons,  as  the 
night  chill  is  often  penetrating  and  is  accentuated  if  the 
clothing  or  the  ground  be  wet.  Mosquito  nets,  while 
not  articles  of  clothing,  may  be  mentioned  here  as  most 
important  in  tropical  countries,  or  hot  weather.  Nothing 
that  the  soldier  carries  is  of  greater  value  in  proportion 
to  its  weight.  It  is  his  most  important  protection  against 
yellow  fever,  malaria,  and  dengue ;  while  it  may  be  quite 
as  efficient  in  protecting  him  from  tick-bites,  from 
the  flies  that  infest  with  screw-worms,  from  poisonous 
insects  and  reptiles.  Its  use,  though  the  importance  of 
it  has  long  been  recognized,  is  apt  to  be  neglected  on 
marches. 

It  is  not  considered  necessary  to  discuss  in  detail  the 
various  articles  and  kinds  of  clothing  to  be  worn,  but 
some  few  articles  need  discussion.  The  drill  regulations 
allow  the  marching  soldier  three  pairs  of  socks,  one  pair 


112     THE   RECRUIT  AND  HIS   ENVIRONMENT 

on  his  feet,  one  in  his  blanket-roll,  and  one  in  his  surplus 
kit  on  the  company  wagon.  In  order  to  keep  his  feet  in 
good  condition  he  should  begin  each  day's  march  with 
clean  feet  in  clean  socks,  and  must  always  have  a  dry 
and  clean  pair  of  socks  for  emergencies,  such  as  the 
accidental  falling  into  mud-puddles  or  streams.  It  is 
therefore  necessary  that  he  should  wash  his  feet  and 
one  pair  of  socks  each  night,  and  the  company  com- 
mander should  make  sure  that  he  does  so,  and  that,  if 
possible,  he  then  has  facilities,  such  as  a  fire,  for  drying 
the  socks.  The  socks  should  not  only  be  clean  and  dry, 
but  they  should  fit  propei'ly.  If  too  long,  they  fold  or 
wrinkle  and  make  pressure  or  rub.  If  too  short,  they 
cramp  the  toes  and  may  be  as  important  in  causing  or 
aggravating  corns,  bunions,  foot-cramp,  and  ingrowing 
toe-nails  as  poorly  fitting  shoes.  They  should  be  of  such 
weight  as  is  suited  to  the  individual  man,  in  general 
being  rather  light  for  foot-troops  so  as  not  to  cause 
excessive  sweating  or  burning  of  the  feet.  Any  disorders 
arising  from  the  use  of  improper  socks  or  from  other 
cause  should  at  once  be  reported  to  the  surgeon,  who, 
by  timely  advice  or  treatment,  may  be  able  to  avert 
lameness  or  disability. 

Shoes  likewise  are  frequent  causes  of  lameness,  and 
in  many  instances  the  company  officer  is  to  blame  for 
not  seeing  that  his  men  get  proper  sizes  and  fits.  At 
other  times  the  quartermaster's  department  is  at  fault 
in  not  having  proper  sizes  for  issue.  In  such  event  the 
man  chooses  a  shoe  of  improper  size,  or  buys  them  of 
improper  shape  and  material  from  civilian  dealers.  The 
footgear  of  the  army  has  improved  in  quality  of  late 
years,  however,  and  most  of  the  shoes  now  issued  are 
excellent,  both  in  shape  and  material.    A  proper  shoe 


THE  HYGIENE   OF   MOVING   TROOPS     113 

should  be  sufficiently  long  and  broad,  so  that  the  toes 
are  not  crowded  even  after  a  long  march.  It  should  not 
make  painful  pressure  on  any  place,  but  should  fit 
snugly  and  evenly  over  the  instep  and  about  the  heel, 
to  prevent  rubbing  or  forward  slipping  of  the  foot.  The 
heel  should  be  broad  and  low.  Two  pairs  of  shoes  are 
allowed,  one  pair  on  the  feet  and  one  pair  in  the  surplus 
kit.  If  practicable,  the  day's  march  should  always  be 
begun  in  a  clean  and  dry  pair,  and  it  is  therefore  im- 
portant that  a  part  of  each  evening's  work  should  be 
the  cleaning,  drying,  and  oiling  of  one  pair.  For  the 
last-named  purpose,  a  piece  of  fat  meat  will  answer  if 
other  oil  is  not  obtainable.  Shoes  left  wet  and  dirty 
soon  become  hard,  wrinkled,  and  uncomfortable,  and 
'•  run  over  "  and  break  more  readily  than  those  kept 
clean  and  supple. 

Two  suits  of  underclothing  are  allowed,  one  on  the 
person  and  one  in  the  surplus  kit.  As  underclothing 
is  even  more  important  as  a  protection  from  dirt  than 
from  cold,  these  will  also  require  frequent  washing. 
Neglect  of  this  may  result  in  attacks  of  boils,  ringworms, 
and  other  skin  infections.  When  a  day  in  camp  permits 
it,  and  coffee  tins  or  other  receptacles  are  available  for 
the  purpose,  underclothing  should  be  boiled. 

Another  article  of  the  field  kit  that  will  require 
frequent  washing  and  occasional  boiling  is  the  towel, 
but  one  being  authorized. 

For  general  purposes,  and  use  in  almost  all  climates, 
it  is  doubted  if  a  more  satisfactory  headgear  than  the 
campaign  hat  has  been  devised.  In  arctic  weather  the 
fur  cap,  and  in  the  tropics  a  cork  or  pith  helmet  will 
excel  it  at  times,  but  for  general  use  it  is  excellent. 
It  should  preferably,  however,  be  freely  ventilated  and 


114    THE   RECRUIT  AND   HIS   ENVIRONMENT 

worn  "  peaked  "  or  uncreased,  so  as  to  have  a  large  air 
space  between  the  top  of  the  hat  and  the  top  of  the 
head.  Much  has  been  written  as  to  the  advantage  of 
red  or  orange  hat-linings  and  underclothing  as  a  pro- 
tection from  the  actinic  rays  of  the  sun.  The  value  of 
such  provision  is  not  yet  determined. 

The  general  rules  for  camp  police  should  be  applied 
to  marches  as  far  as  practicable,  and  they  can  be  ap- 
.  plied  to  a  far  greater  extent  than  is  ordi- 

narily the  case.  In  order  to  do  this,  proper 
instructions  should  be  given  in  advance,  and  each  com- 
pany should  have,  as  in  camp,  at  least  one  man  on 
sanitary  police  duty,  whose  business  it  would  be  to  see 
to  the  proper  disposal  of  waste  matters,  to  prevent  the 
careless  and  indiscriminate  soiling  of  halting-places,  to 
assist  in  preventing  the  use  of  improper  water,  and  to 
do  such  other  work  of  a  similar  character  as  the  cir- 
cumstances necessitate  or  the  medical  officer  recom- 
mends. He  should  carry  a  spade.  Men  should  not, 
except  in  urgent  cases,  be  allowed  to  fall  out  except  at 
regular  halts.  If  the  halt  is  a  short  one,  the  company 
commander  indicates  to  the  sanitary  soldier  a  suitable 
spot  for  urine  and  feces.  The  man  goes  to  that  spot  and 
remains  there.  All  men  needing  to  fall  out  go  there  and 
use  the  place  indicated,  afterward  covering  their  dejecta 
with  earth.  If  the  halt  is  longer,  half  an  hour  or  more, 
the  sanitai'y  soldier  repairs  at  once  to  the  designated 
spot  and  digs  a  shallow  trench  for  feces  and  a  shallow 
pit  for  urine.  All  men  should  be  instructed  to  use  these 
places  only,  and  the  trench  and  pit  should  be  filled  in 
again  before  the  march  is  resumed.  In  case  a  man,  from 
urgent  necessity,  does  fall  out  on  the  march,  he  should 
be  instructed  to  cover  his  feces  with  earth,  using  his 


THE  HYGIENE   OF   MOVING   TROOPS     115 

bayonet,  if  necessary,  for  the  purpose.  Similar  rules 
should  apply  to  men  on  outpost  or  picket  duty,  and  in 
this  way  much  may  be  done  to  prevent  the  surroundings 
of  a  camp  from  becoming  an  ill-smelling,  fly-breeding 
nuisance.  Scraps  of  food,  greasy  papers,  and  other  ar- 
ticles thrown  away  by  the  men  at  the  halting-place, 
should  be  thrown  into  one  pit  and  burned  or  bui-ied. 

On  arrival  at  camp,  the  sanitary  soldier  should  im- 
mediately begin  shallow  trenches  in  a  proper  place 
selected  by  the  medical  officer,  and  men  should  be 
punished  for  urinating  or  defecating  elsewhere.  After 
that,  the  other  business  of  making  camp  may  proceed. 
Without  it,  the  camp  should  not  be  made,  as  its  site 
will  almost  certainly  be  defiled. 

In  bivouac,  or  while  actually  marching,  the  men 
should  take  all  possible  precautions  to  protect  them- 
selves from,  or  to  rid  themselves  of,  vermin  and  insects, 
and  in  warm  weather  the  use  of  the  mosquito  net  should 
not  be  neglected. 

The  hygiene  of  the  battlefield  has  been  largely  set 
forth  in  the  consideration  of  the  camp  and  the  march. 
All  the  general  principles  there  set  down     _       . 
hold  good  and  should  be  observed  as  far     ^  .  , 
as  possible.   Often,  however,  the  military     „ 
necessities  allow  no  time  to  be  devoted  to 
sanitary  matters;  but  even  so,  the  soldier  trained  to  a 
realization  of  the  importance  of  such  matters  will  be 
able  to  take  better  care  of  himself  and  to  do  less  harm 
to  his  comrades  than  the  man  not  so  trained. 

The  man  going  into  battle  should,  if  possible,  ob- 
serve all  of  the  following  rules  in  addition  to  the  gen- 
eral care  outlined  above  :  — 

1.  Make  sure  that  you  have  a  first-aid  packet,  that 


116     THE   RECRUIT  AND   HIS   ENVIRONMENT 

it  is  in    good  condition,  and    that  you  know  how  to 
use  it. 

2.  Have  your  canteen  full  of  boiled  water. 

3.  Be  clean  in  person  and  clothing,  be  bathed,  and 
have  on  fresh  underclothing. 

4.  Have  your  bowels  and  bladder  empty. 

5.  Eat  only  good,  nourishing,  and  digestible  food. 

All  of  these  rules  have  an  important  hygienic  bear- 
ing in  case  he  should  be  wounded.  The  introduction  of 
the  first-aid  packet  in  its  present  form  was  probably 
the  greatest  improvement  in  military  hygiene  ever  con- 
summated, and  it  has  prevented  an  immense  amount 
of  suffering,  mutilation,  and  death.  For  a  large  pro- 
portion of  wounds,  a  properly  applied  first-aid  dressing 
constitutes  the  most  important  part  of  the  treatment, 
and,  in  many  cases,  the  whole  of  it.  With  such  a  dress- 
ing at  hand  and  a  knowledge  as  to  how  to  apply  it,  the 
use  of  water  on  wounds  is  very  rarely  necessary.  But 
if  water  is  used,  it  is  most  important  that  it  should  have 
been  boiled.  Otherwise  it  may  infect  the  wound  most 
seriously.  Cleanliness  of  person  and  clothing  are  very 
important  for  the  same  reason,  to  prevent  infections. 
Most  infections  of  wounds  are  caused  by  bacteria  de- 
rived from  the  skin  or  its  coverings,  and  by  simple 
cleanliness  of  these,  surgeons  are  daily  able  to,  and  do, 
make  extensive  wounds  that  heal  without  a  trace  of 
infection.  The  importance  of  having  the  bowels  and 
bladder  empty,  or  relatively  so,  lies  in  the  fact  that 
wounds  ot  these  viscera  are  exceedingly  dangerous,  but 
that  the  danger  is  directly  lessened  with  the  chances  of 
exeremental  soiling  of  the  tissues.  For  this  reason, 
eating,  drinking,  and  moving,  all  of  which  increase  or 
facilitate  the  escape  of  intestinal  or  bladder  contents, 


THE   HYGIENE  OF  MOVING  TROOPS     117 

are  to  be  avoided  in  the  case  of  belly  wounds,  and  for 
the  man  so  wounded  we  may  formulate  another  rule  : 

6.  If  wounded  in  the  belly,  lie  down  in  the  most 
comfortable  position,  eat  nothing,  drink  little  or  no- 
thing, do  not  move,  do  not  get  excited  or  restless.  If 
overlooked  or  forgotten,  you  may  be  better  off  than  if 
found  and  transported. 

The  sanitary  disadvantages  under  which  men  travel 
on  our  army  transports  are  numerous,  but  they  are 
mostly  beyond  the  company  officer's  power  „ 
to  remedy.  The  transport  regulations  pro-  ^ 

vide  for  such  sanitary  measures  and  daily  '^ 

inspections  as  would  seem  to  assure  good  conditions, 
and  the  conditions  are  such  that  with  the  aid  derived 
from  sea  air  and  changes  of  scene  the  health  of  the 
men  is  usually  well  preserved  or  impi'oved.  Over-crowd- 
ing is  an  evil  frequently  encountered  on  transports, 
and  one  from  which  others  flow.  The  company  com- 
mander is  quite  powerless  to  prevent  this,  but  he 
should  lessen  the  evils  of  it  by  having  his  quarters  as 
freely  ventilated  as  possible,  having  them  policed  each 
day,  and  vacated  by  both  men  and  their  belongings 
when  opportunity  offers.  He  should  see  that  his  men 
bathe  frequently  and  have  frequent  changes  of  under- 
clothing, and  that  they  get  suitable  opportunities  for 
clothes- washing. 

Transports  are  not  infrequently  infested  with  hed- 
hugs.  The  company  officer  can  only  partially  correct 
this  evil  by  the  police  and  cleanliness  of  his  quarters, 
and,  at  times,  by  bed-bug  hunts  and  the  use  of  insect- 
icides. 

The  food  on  transports  is  usually  of  good  quality 
and  very  nourishing,  but  the  methods  of  cooking  and 


118    THE  RECRUIT  AND  HIS  ENVIRONMENT 

serving  it  are  almost  always  monotonous  and  unat- 
tractive, and  result  in  unnecessary  waste,  improper 
methods  of  eating,  and  some  disgust  with  the  food.  The 
company  officer  should  try  to  influence  these  condi- 
tions for  the  better,  so  far  as  he  can  do  so.  Owing  to 
the  long  confinement  in  exceedingly  narrow  limits  dur- 
ing the  trans-Pacific  voyage,  unremitting  attention  to 
all  sanitary  details  is  urgently  demanded.  All  cases  of 
sickness  or  disease  of  any  kind  should  be  reported  to 
the  surgeon  early,  in  order  that  he  may  isolate  conta- 
gious diseases,  as  well  as  give  treatment.  The  two  ills 
from  which  a  majority  of  men  suffer  are  sea-sickness 
and  constipation,  the  former  at  the  beginning  of  the 
voyage,  the  latter  throughout  it.  The  tendency  to  sea- 
sickness is  lessened  if  the  man  goes  aboard  the  boat  in 
good  general  condition,  with  his  bowels  cleaned  out  and 
his  system  free  from  the  poisons  produced  by  over- 
eating, alcoholism,  and  other  excesses.  Constipation 
should  be  prevented,  if  possible,  by  the  use  of  rather 
bulky  foods,  such  as  oatmeal,  fruits,  and  vegetables,  by 
daily  exercise  and  a  well-maintained  habit  of  visiting 
the  closet  regularly  and  making  the  effort  to  defecate. j 
Under  varying  conditions,  troop  trains  may  be  com- 
posed of  any  kinds  of  cars  that  are  in  use.  The  geu- 

eral  principles  of  troop  hygiene  should  be 
.  applied  as  far  as  practicable,  whatever  the 

accommodations.  The  most  common  faults 
in  troop  trains  in  time  of  peace  are  poor  policing  and 
dirty  cars,  and  an  insufficiency  of  water  for  drinking 
and  cleaning  purposes.  Both  of  these  faults  are  usu- 
ally attributable  to  the  railway  officials,  but  the  troops 
are  partly  to  blame  in  that  they  are  sometimes  care- 
less and  wasteful  of  the  water,  and  make  very  little 


THE  HYGIENE  OF  MOVING  TROOPS     119 

effort  to  keep  the  cars  clean.  The  company  commander 
can  therefore  partially  control  the  evils.  He  should  also 
make  it  his  particular  care  to  see  that  the  car  closets 
are  well  supplied  with  water  for  flushing  purposes,  and 
that  the  supply  is  replenished  as  opportunity  offers. 


CHAPTER  VII 

THE   HYGIENE   OF   HOT   AND   COLD   CLIMATES 

The  general  principles  of  hygiene  are  the  same  the 
world  over  and  may  be  applied  in  any  climate.  They 
aim  to  keep  the  body  strong,  sound,  free  from  infection, 
and  at  its  maximum  efficiency.  Inasmuch,  though,  as  the 
dangers  of  infection  as  well  as  of  injury  from  extremes 
of  temperature  are  somewhat  different  in  the  tropics 
and  the  arctics,  it  is  well  to  give  these  conditions  sepa- 
rate consideration. 

Hot  Countries 
The  danger  to  life  and  health  is  greater  in  nearly 
all  tropical  countries  than  in  those  that  are  temper- 
ate. This  is  due  to  a  number  of  causes,  among  which 
we  may  note  the  almost  total  neglect  or  ignorance  of 
sanitation  among  tropical  peoples,  the  high,  even,  and 
often  moist,  temperature  in  which  disease-producing 
organisms  flourish  and  multiply,  the  great  abundance 
and  variety  of  insect-life,  the  common  pollution  of 
water-supplies,  the  habits  of  dress,  and  the  heat  itself. 
It  is  sometimes  said  that  the  safest  procedure  in  matters 
of  hygiene  in  strange  countries  or  climates  is  to  con- 
form to  the  habits  of  the  natives,  but  this  is  often  a 
very  serious  error,  and  it  has  undoubtedly  cost  many 
lives.  It  is  faulty  habits  in  the  natives  that  help  to  keep 
alive,  in  the  tropics,  many  diseases  that  have  long  since 
almost  or  entirely  disappeared  from  temperate  climes, 
while  the  people  sicken  and  die  of  preventable  infec- 


HYGIENE   OF   HOT  AND   COLD  CLIMATES   121 

tious  diseases   in  far  greater  numbers  than  should  be 
the  case. 

The  native  of  the  tropics  is  very  apt  to  suffer  from 
water-borne  diseases,  and  cholera  and  dysenteiy,  al- 
though not  limited  to  tropical  climates,  are 
so  much  less  prevalent  elsewhere  as  to  be 
relatively  rare,  even  if  not  unknown.  The  native  is  in- 
fluenced in  his  choice  of  a  water-supply  by  convenience, 
superstition,  habit,  and  the  fact  that  his  ancestors  did 
certain  things,  but  not  often  by  sanitary  considerations. 
For  this  reason  he  suffers  from  the  diseases  mentioned, 
and  partly  for  this  reason  he  practically  always  harbors 
one  or  more  varieties  of  intestinal  worms.  The  only 
safe  rule  for  general  application  to  drinking-water  in 
the  tropics  is  that  it  should  be  sterilized  b}'  boiling,  dis- 
tillation, or  passage  through  germ-proof  filters.  But 
this  alone  is  not  snfficient.  The  water  must  be  kept 
sterile  until  consumed,  by  being  put  \i\  sterile  contain- 
ers and  closed  against  all  possible  contaminations.  Both 
Filipino  and  Chinese  servants  in  the  Philippines  are  so 
entirely  ignorant  of  the  very  meaning  of  sanitary  pre- 
cautions, that  they  are  continually  guilty  of  such  action 
as  stoppering  bottles  of  distilled  water  with  corks  they 
have  held  in  their  mouths,  wiping  out  a  drinking-glass 
with  a  dirty  rag  or  paper  picked  from  the  floor,  drink- 
ing direct  from  bottles,  and  bottling  unboiled  water 
rather  than  take  the  trouble  of  boiling  it,  and  it  is  feared 
that  not  all  soldiers  are  free  from  some  of  these  faults. 

It  is  generally  asserted,  and  is  theoretically  true, 
that  less  food  is  required  in  the  tropics  than  in  colder 
climates,  and  that  the  fats  and  proteids  in 
particular  should  be  considerably  reduced. 
This  may  be  admitted,  but  we  must  also  admit  that 


122    THE   RECRUIT  AND  HIS  ENVIRONMENT 

lifelong  habits,  exercise,  and  temperament  exert  an 
influence  that  cannot  be  ignored,  and  any  arbitrary 
attempt  to  put  American  soldiers,  especially  if  they  be 
doing  field-work,  on  a  ration  approaching  the  rice-and- 
fish  diet  on  which  many  natives  of  the  tropics  live, 
will  result  not  only  in  discontent,  but  also  in  impaired 
nutrition  and  in  clandestine  indulgence  in  food  or  drink 
of  improper  character.  The  present  army  ration  is 
thought  to  be  excellent  for  the  tropics,  as  for  home, 
provided  that  the  men  wo7'k  and  exercise  as  at  home. 
If  such  is  not  the  case,  the  ration  is  too  heavy  and 
should  be  reduced  as  indicated.  The  sugars  and  starches 
are  well  borne  in  the  tropics,  are  not  such  "  heating  " 
food  as  fat  and  proteid,  and  tlo  not  tend,  in  the  same 
way  and  same  degree,  to  cast  an  excessive  amount  of 
work  on  the  liver  and  kidneys.  Neither  do  they  offer 
opportunities  for  such  harmful  forms  of  intestinal  putre- 
faction. Organic  acids,  such  as  fruit-juices,  are  espe- 
cially valuable  and  important,  as  well  as  agreeable,  in 
the  tropics. 

Care  must  be  exercised  in  the  use  of  fresh  fruits  and 
green  vegetables,  not  because  they  are  in  themselves 
harmful,  but  because  they  are  apt  to  be  contaminated, 
from  unclean  water  or  from  fecal  manuring,  with  the 
parasites  causing  intestinal  diseases.  The  only  safe 
plan  in  using  them  in  countries  where  dysentery,  chol- 
era, and  intestinal  worms  abound  is  to  have  them 
sterilized :  the  green  vegetables  and  some  fruits  by 
cooking ;  bananas,  mangoes,  oranges,  and  similar  thick- 
skinned  fruits,  by  thorough  washing  in  boiled  water. 
A  large  part  of  the  food  consumed  by  white  people 
in  the  tropics  is  preserved  by  refrigeration  or  by  can- 
ning.   It  is  as  good  there  as  elsewhere,  but  is  apt  to 


HYGIENE  OF  HOT  AND  COLD  CLIMATES    123 

decompose  rapidly  after  exposure  to  the  ordinary  tem- 
perature and  atmospheric  conditions,  and  should  there- 
fore be  used  promptly  after  such  exposure. 

Owing  to  the  facility  with  which  potatoes  and  similar 
vegetables  spoil,  the  tropical  resident  should  early  ac- 
custom himself  to  the  use  of  rice,  yams,  and  similar 
products.  The  use  of  condiments  and  spices  is  gener- 
ally more  liberal  in  the  tropics  than  elsewhere.  This 
is,  partly  at  least,  a  matter  of  custom,  but  it  may  have 
a  physiological  basis  in  that  these  articles  are  stimu- 
lant to  the  alimentary  tract.  They  are  not  known  to 
do  harm. 

Alcohol  is  quite  as  much  abused  by  northern  peoples 
in  the  tropics  as  in  their  own  homes,  or  more  so.    In 
real  moderation,  that  is,  in   the  amounts 
that  can  be  completely  oxidized  in  the  body  cono 

and  used  as  food,  it  is  not  known  that  alcohol  is  more 
harmful  in  the  tropics  than  elsewhere.  In  greater 
amount  it  is  so,  for  the  reason  that  alcohol  in  excess  is 
in  all  climates  an  irritant  to  the  liver,  and  in  the  tropics 
the  liver  is  already  hard-worked,  irritated,  "  sluggish," 
and  subject  to  congestions, — conditions  aggravated  by 
the  irritation  from  the  alcohol.  Like  the  proteids  and 
fats  it  does  less  harm  if  plenty  of  exercise  is  taken  to 
promote  its  oxidation  and  the  elimination  of  the  com- 
bustion-products. As  in  other  climates,  its  use  is  only 
infrequently  indicated,  and  abstinence  from  it  is  advis- 
able. Its  very  general,  and  often  excessive,  use  among 
soldiers  proceeds  not  so  much  from  any  needs  of  the 
system  as  from  idleness,  vacancy  of  mind,  evil  exam- 
ples or  careless  associations,  laxity  of  public  opinion 
on  such  matters,  and  absence  of  such  restraining  influ- 
ences as  home-life  and  respectable  female  society.   It 


124    THE   RECRUIT  AND  HIS   ENVIRONMENT 

would  therefore  seem  that  the  company  officer  can  best 
combat  the  evil  by  attention  to  these  points.  Heat- 
stroke and  heat-exhaustion  are  much  more  apt  to  occur 
in  a  man  who  is  drinking,  and  to  be  more  severe  when 
they  do  occur.  All  drinking  to  excess  is  debilitating 
and  probably  lessens  the  resistance  to  infections.  Re- 
currences of  malaria  and  dysentery  are  not  infrequently 
brought  on  by  drinking-bouts  or  sprees.  Alcohol  also 
predisposes  in  more  indirect  ways  to  disease-infections, 
as  by  rendering  a  man  neglectful  of  the  quality  of  his 
food  or  the  use  of  his  mosquito  net,  and  because  he 
may  use  impure"  water  with  his  drink,  erroneously 
trusting  to  the  alcohol  to  sterilize  it. 

In  general  terms,  the  dress  should  be  adapted  to  the 
climate  and  to  insure  comfort  and  protection.  The 
clothing  issued  to  the  ai-my  fulfills  these 
^  requirements,  allowing  variations  in  the 
underclothing  to  suit  individual  tastes  and  require- 
ments. The  cotton  khaki  for  outer  dress  is  cheap, 
strong,  durable,  fairly  cool,  and  easily  washed.  The 
flannel  shirt  for  the  field  and  that  of  blue  cotton  for 
barracks  meet  the  requirements.  British  writers  lay 
some  emphasis  on  the  desirability  of  always  wearing 
woolen  clothing  in  order  to  protect  from  chill,  and 
much  has  been  said  as  to  the  value  of  the  woolen 
belly-band  or  abdominal  binder.  The  writer's  personal 
experience,  and  observations  as  to  the  general  American 
experience,  in  the  tropics  do  not  indicate  that  this  is  a 
rule  of  general  application.  As  stated  before,  most 
tropical  diseases  are  infectious  in  nature,  and  if  proper 
precautions  be  taken  to  avoid  the  infections,  it  is  not 
thought  that  the  discomfort  produced  by  too  great 
warmth  of  body,  excessive  perspiration,  and  prickly 


HYGIENE  OF   HOT  AND   COLD  CLIMATES     125 

heat  is  apt  to  offer  additional  protection.  In  the  field, 
where  the  chill  of  night  air  is  more  keenly  felt  and 
where  wetting  may  occur  from  rain  or  from  fording 
streams,  the  flannel  shirt  should  be  worn,  and  it  and. 
the  blanket  meet  the  requirements.  There  is  no  objec- 
tion to  the  use  of  light  flannels  by  men  who  find  them 
comfortable,  while  in  the  cold  season  and  in  high  lands, 
as  at  Baguio  in  Luzon,  they  may  be  much  needed ;  but 
for  most  of  the  service  to  which  our  men  have  been 
subjected  in  the  tropics  they  are  a  source  of  harm 
rather  than  of  good.  I>ight-weight  cotton  undershirts, 
with  short  sleeves,  and  muslin  drawers  not  coming 
much  below  the  knees  are  preferred.  The  clothing 
worn  in  the  tropics  requires  frequent  washing  and  fre- 
quent changing,  and  a  good-sized  laundry  bill  is  a 
necessity.  The  clothing  is  usually  sun-dried,  and  that 
is  an  important  aid  in  destroying  germs  on  it.  Most 
native  wash-men  do  not  boil  it,  but,  if  feasible,  they 
should  be  required  to  do  so. 

The  campaign  hat,  as  previously  stated,  is  an  excel- 
lent article  for  field  use,  but  it  should  be  well  ventilated 
by  openings  in  the  sides,  and  should  be  worn  in  such  a 
manner  as  to  preserve  a  large  air-space  above  the  head. 
The  khaki  cap  offers  very  little  protection  from  either 
heat  or  light,  and  should  be  superseded  for  garrison  use 
by  a  straw  hat  or  a  helmet,  the  latter  preferably  of  pith 
or  cork.  Much  has  been  said  and  written  of  late  about 
the  value  of  protection  from  the  actinic  or  invisible  rays 
of  the  sun,  and  helmets  with  an  interlining  of  metal  foil, 
and  hat-linings,  underclothing,  and  spine-protectors  of 
black,  red,  or  orange  material,  have  been  advocated  as 
means  of  protection  from  them.  The  value  of  such  pro- 
tection and  of  these  means  are  yet  in  doubt  and  they 


126    THE   RECRUIT   AND   HIS  ENVIRONMENT 

must  remain  so  for  some  time.  The  evil  effects  ascribed 
to  the  actinic  rays  are  principally  those  manifesting 
themselves  as  functional  nervous  disorders.  Such  dis- 
orders are  notoriously  hard  to  trace  to  a  definite  cause, 
and,  on  the  other  hand,  the  sufferers  from  them  are  the 
most  favorable  subjects  for  treatment  by  mental  sug- 
gestion. Therefore,  the  fact  that  a  number  of  such 
sufferers  are  benefited  by  the  use  of  red  underclothing 
is  not  conclusive  evidence  that  their  ills  were  caused  by 
actinic  rays. 

Shoes  should  always  be  worn  in  the  tropics  as  a  pro- 
tection against  infections.  Comfort  and  fit  should  be 
considered  as  elsewhere,  but  because  it  is  comfortable 
to  go  barefooted  is  not  sufficient  reason  for  doing  it. 
One  of  the  greatest  causes  of  sickness  and  debility  in 
the  tropics  is  the  hookworm,  and  as  it  usually  gains 
entrance  to  the  body  through  the  skin  of  the  feet,  the 
general  use  of  shoes  is  looked  upon  as  an  important 
method  of  protection  against  it.  Plague  infection  usu- 
ally occurs  through  flea-bites  on  the  feet  and  legs.  Other 
infections  occur  in  the  same  way;  and  the  subject  will 
be  discussed  at  greater  length  in  another  chapter.  Shoes 
and  leggings  also  protect  against  leeches,  ticks,  mosqui- 
toes, and  other  insects. 

Because  of  the  heat,  the  relative  cheapness  of  native 
servants,  and  his  comparative  wealth,  the  American  is 
_  apt  to  neo;lect  outdoor  exercise  in  the  trop- 

ics.  It  is  very  important  that  he  should  not 
do  this,  as  abundant  experience  has  shown  that  it  lessens 
the  liability  to  the  nervous  breakdowns  that  constitute 
one  of  the  chief  causes  of  invaliding  from  the  tropics. 
It  is  desirable  that  the  glare  and  heat  of  midday  be 
avoided  as  times  for  such  exercise,  the  early  morning  or 


HYGIENE  OF  HOT  AND   COLD  CLIMATES     127 

the  evening  being  preferred.  The  exercise  should  be 
incidental  to  interesting  work  or  play.  Tennis,  polo, 
football,  horseback-riding,  and  hunting  are  excellent 
forms.  Marching  is  also  good  if  the  men  are  interested 
and  cheerful.  After  the  exercise,  which  should  be  suffi- 
ciently violent  to  produce  a  good  sweat,  the  body  should 
be  bathed,  well  rubbed  down,  and  dry  clothing  put  on. 
Swimming  is  also  a  good  form  of  exercise  and  one  that 
should  be  encouraged,  as  every  soldier  should  be  a  good 
swimmer. 

With  proper  precautions  as  to  exposure  to  the  sun, 
the  prevention  of  chill  from  wet  clothing,  and  the 
avoidance  of  great  fatigue,  it  is  thought  that  exercise 
will  do  only  good.  Many  white  men  in  the  tropics  suffer 
from  lack  of  it,  very  few,  and  they  are  usually  diseased, 
from  excess.  Its  value  lies  in  the  promotion  of  the  active 
functioning  of  the  skin,  liver,  and  other  organs  of  waste 
elimination,  and  the  resulting  improved  nervous  control, 
rather  than  in  increase  of  muscular  strePj-jth.  Without 
exercise,  alcohol,  tobacco,  and  excesses  iii  food  are  all 
doubly  harmful. 

Because  of  the  freer  perspiration  and  the  greater  lia- 
bility to  skin  diseases  in  the  tropics,  more  frequent 
baths  and  changes  of  clothing  are  necessary 
than  in  temperate  regions.  The  bath  water  ° 

should  not  be  sufficiently  cold  to  produce  shock  or  chill, 
but  as  such  water  cannot  usually  be  obtained  in  the 
tropics,  that  feature  need  not  require  much  considera- 
tion. Persons  who  have  suffered  from  malaria  or  dysen- 
tery or  other  intestinal  troubles  should  use  tepid  or 
warm  water.  It  should  be  remembered  that  typhoid, 
dysentery,  cholera,  and  certain  infestations  with  animal 
parasites  may  be  contracted  by   bathing  in  polluted 


128    THE   RECRUIT  AND  HIS   ENVIRONMENT 

streams  or  ponds,  and  such  places  should  therefore  be 
avoided.  Whatever  the  source  of  the  water,  care  should 
be  taken  that  it  does  not  get  into  the  month  and  so 
carry  infection.  After  the  bath  the  body  should  be 
thoroughly  dried,  particular  attention  being  paid  to  the 
arm-pits,  crutch,  and  groins,  aiid,  if  these  parts  sweat 
profusely,  it  is  well  to  dabble  them  with  some  antisep- 
tic solution  and  then  dry  them  again,  after  which  they 
may  be  dusted  with  talcum  powder.  Fresh  and  dry 
underclothing  must  be  then  donned.  If  prickly-heat 
eruptions  are  present  or  appear  easily,  a  weak  formalin 
solution,  about  one  teaspoonful  of  formalin  to  a  pint  or 
a  quart  of  water,  may  be  used  to  sponge  the  body  after 
it  is  washed  and  before  drying.  It  is  thought  that  the 
measures  here  advised  are  as  good  as  are  known  for 
the  prevention  of  the  prickly  heat,  small  boils,  chafing, 
and  "  dhobie  itch  "  or  ringworms  that  cause  so  much 
annoyance  and  irritation  in  the  tropics.  In  addition,  it 
should  be  rwiiembered  that  some  of  these  affections 
are  contagious,  and  contact  with  persons  having  them 
should  be  avoided.  Soldiers  occasionally  borrow  articles 
of  clothing  from  one  another,  and  that  is  another 
method  of  spreading  skin  diseases.  In  Japan  it  is  still 
a  rather  common  custom  for  many  people  to  bathe  in 
the  same  tub  or  tankful  of  water,  and  that  probably 
accounts  for  much  of  the  abundant  skin  disease  seen  in 
that  country.  Such  a  practice,  though  economical  of 
fuel  and  water,  is  to  be  avoided. 

The  heat,  the  bright  light,  the  new  and  strange  en- 

^  ,         vironment,  the  native  habits  of  both  dress 

.  and  conduct,  unite  to  stimulate  and  excite 

^°  the  sexual  desires  of  the  new-comer  in  tlie 

tropics,  while  his  money  and  the  native  habits,  poverty, 


HYGIENE  OF  HOT  AND  COLD  CLIMATES     129 

and  views  of  morality,  constitute  a  set  of  circumstances 
enabling  him  to  gratify  them.  In  consequence  he  is  apt 
to  indulge  in  such  sexual  excesses  as  impair  his  nervous 
control,  unless,  as  is  frequently  the  case,  he  is  soon  or 
often  checked  by  venereal  disease.  Later,  when  he  be- 
comes debilitated  by  his  excesses  or  by  other  causes, 
his  sexual  vigor  fails  and  he  begins  to  worry  about 
that,  thus  aggravating  and  accentuating  his  trouble. 
Nothing  that  is  equally  harmless  so  profoundly  affects 
the  mind  of  the  average  young  man  as  the  loss,  even 
though  it  be  temporary,  of  his  sexual  vigor,  and  nothing 
so  prolongs  and  aggi-avates  that  loss  as  continual  brood- 
ing over  it ;  so  in  this  combination  we  have  the  making 
of  neurasthenia  and  melancholia.  Each  man  should 
know  that  his  sexual  needs  are  not  greater  in  the 
tropics  than  elsewhere,  that  sexual  or  other  excesses 
may  bring  about  nervous  exhaustion  and  temporary 
loss  of  sexual  power,  and  that  the  best  rules  in  the 
tropics,  as  elsewhere,  are:  1.  Sexual  continen^^p  ;  9^ 
Avoidance  of  obscenity  and  indecency  ;  3.  Cleanliness  ' 

of  the  genitals ;   4.  Complete  avoidance  of  thought  or\  I  '^^ 
handling  of  them,  except  for  legitimate  and   proper  /  "^^^orJ 
purposes. 

The  necessity  for  thorough  policing  and  cleanliness 
of  houses  and  grounds  is  even  more  important  in  the 

tropics    than    elsewhere,    because    of    the 

,  1  c  •         J     r  Police 

greater  prevalence  ot  vermm  and  ot  ver- 

min-borne  diseases.  Malaria,  yellow  fever, 
dengue  plague,  and  other  insect-borne  dis- 
eases, occur  principally  in  the  tropics,  and 
are  best  combated    by  such  methods  of    policing  as 
do  away  with  the  feeding  or  breeding  places  of  the 
insects  carrying  them.  In  addition,  roaches  and  ants 


9^^' 


130    THE  RECRUIT  AND  HIS   ENVIRONMENT 

abound  in  numbers  and  with  a  persistency  not  seen 
elsewhere,  and,  as  they  run  impartially  in  water-closets 
and  food-chests,  it  is  easily  conceivable  that  they  may 
transmit  disease.  Rats  and  mice  constitute  not  only 
an  annoyance  but  also  a  great  and  positive  source  of 
danger,  because  it  is  among  them  that  epidemics  of 
plague  begin,  and  it  is  from  such  rat  epidemics  that 
those  among  people  take  their  origin.  Parasitic  skin 
affections  prevail  very  widely  among  persons,  domestic 
animals,  and  fowls,  and  it  is  partly  by  cleanliness  of 
habitation  that  we  escape  them. 

All  the  usual  sanitary  precautions  as  to  cleanliness, 
plumbing,  and  good  policing  are  to  be  observed  in  the 
tropics  as  elsewhere  ;  but  additional  care  must  be  given 
to  all  standing  water  both  inside  the  house  and  out,  to 
prevent  mosquitoes  breeding  in  it.  Such  collections 
should  not  be  allowed  if  they  can  be  avoided.  If  allowed 
to  exist,  the  water  should  be  completely  emptied  and 
renewed  once  in  four  or  five  days  at  most,  or  should  be 
kept  covered  with  a  film  of  mineral  oil,  which  can  be 
renewed  at  like  intervals.  Ponds  or  other  large  collec- 
tions should  be  stocked  with  fish,  and  the  general  pre- 
cautions against  mosquitoes,  to  be  outlined  later,  should 
be  observed.  Mosquito-proof  houses,  while  in  quite 
general  use  in  our  own  country,  are  still  not  in  use  by 
us  in  our  tropical  stations,  and  the  fact  is  inexcusable. 
Our  army  practice  has  not  nearly  kept  pace  with  our 
knowledge,  and  it  is  hoped  that  officers  will  spare  no 
pains  to  have  their  barracks  and  quarters  screened  as 
a  measure  of  comfort  and  of  sanitation. 


HYGIENE  OF  HOT  AND  COLD  CLIMATES     131 

Very  Cold  Climates 

The  principal  sanitary  dangers  menacing  the  dwellers 
in  very  cold  climates,  aside  from  lack  of  food  and  other 
things  outside  of  our  present  consideration,  arise  from 
exposure  to  cold,  resulting  in  frost-bite  or  freezing,  from 
poor  ventilation,  from  too  intimate  association  with 
diseased  persons  or  animals,  from  improper  food  or 
lack  of  fresh  food.  Infectious  diseases  are  less  numerous 
than  elsewhere,  as  their  germs  do  not  find  such  favor- 
able surroundings  in  which  to  grow,  and  there  are  fewer 
persons  to  harbor  and  distribute  them. 

The  outdoor  air  of  arctic  regions  is  purer  and  freer 
from  disease-producing  organisms  than  that  of  other 
regions.  Man-polluted  air  is  as  dangerous  . 
there,  however,  as  elsewhere.  As  ventilation 
and  heating  are,  from  a  sanitary  standpoint,  insepara- 
ble, and,  as  free  ventilation  makes  heating  more  diffi- 
cult because  of  the  greater  volume  of  air  that  must  be 
warmed,  it  may  be  understood  at  once  that  the  natural 
tendency  in  an  arctic  climate  is  to  have  poor  ventilation. 
Every  increase  in  ventilation  lets  in  cold  and  allows 
heat  to  escape,  and  tlie  discomfort  of  this  is  more 
acutely  and  keenly  felt  than  that  due  to  foul  air  ;  so  the 
effort  to  keep  warm  may  cause  the  air  to  become  vile. 
As  animal  heat  helps  materially  to  warm  a  crowded 
space,  and  as  crowding  lessens  the  consumption  of  fuel, 
man  and  dogs,  sick  and  well,  are  thrown  into  close  con- 
tact. If  one  man  in  a  crowded,  ill-ventilated  room  has 
tuberculosis,  diphtheria,  tonsillitis,  measles,  smallpox,  or 
other  contagious  malady,  the  contagium  or  poison  is  so 
concentrated  as  to  make  all  present  unusually  liable  to 
contract  the  disease. 


132    THE   RECRUIT   AND  HIS   ENVIRONMENT 

Ventilation,  therefore,  should  be  as  free  as  possible, 
care  being  taken  to  warm  the  incoming  air.  Crowding 
should  be  avoided,  and  as  much  time  as  possible  be 
spent  in  the  open.  Particularly  should  intimate  associa- 
tion in  crowded  rooms  witli  sick  persons  be  avoided. 
The  intimate  contact  with  sick  and  with  animals  is  also 
productive  of  disease  in  other  ways  than  that  indicated 
above.  A  man  having  gonorrhoea  or  syphilis  is  in  such 
circumstances  much  more  apt  to  infect  innocently  and 
unknowingly  those  about  him  than  he  would  be  under 
other  conditions.  Echinococcus  disease,  due  to  infesta- 
tion with  a  certain  dog  tapeworm,  is  almost  limited  to 
persons  brought  into  such  intimate  contact  with  dogs 
as  is  here  mentioned.  Cleanliness  is  almost  impossible 
under  such  conditions,  and  wounds  are  thereby  very  apt 
to  become  infected. 

A  pure  water-supply  is  not  such  a  rarity  in  the  arctics 
as  in  the  tropics,  both  because  pathogenic  germs  do  not 
„,  flourish  in  arctic  temperatures  and  because 

men  are  less  numerous  as  sources  oi  pollu- 
tion. The  danger  of  pollution  of  a  supply  is  greatest  in 
the  spring  and  summer,  when  melting  snow  may  wash 
into  it  the  excrement  that  was  scattered  in  the  neigh- 
borhood during  the  very  cold  weather.  Excrement  is 
apt  to  be  so  scattered,  for  the  reasons  that  other  disposal 
may  be  more  troublesome  and  that  snow  and  freezing 
prevent  its  constituting  a  nuisance  to  the  nose  and  ej^es. 
Especial  care  should  be  exercised  to  prevent  anything 
of  the  kind,  and  drinking  water  should  always  be  taken 
from  points  above  any  possibility  of  such  contamination. 
Attempts  should  not  be  made,  particularly  on  marches, 
to  quench  thirst  with  snow  or  ice,  as  they  detract  from 
the  local  and  general  heat  of  the  body,  and  are  liable 


HYGIENE  OF  HOT  AND  COLD   CLIMATES     133 

to  irritate  the  mouth  and  throat.  Snow  and  ice  may  fur- 
nish the  water-supply,  but  they  must  be  melted  and  the 
water  heated,  when  it  may  be  profitably  used  in  making 
tea,  which  is  then  refreshing,  comforting,  and  stimulat- 
ing, and  adds  to  the  warmth  of  the  body. 

The  food-supply  of  the  arctics  consists  largely  of 
canned  goods,  and  may  be  quite  generous.  Every  effort 
should  be  made  to  supplement  that  diet 
with  fresh  articles,  whether  of  animal  or 
vegetable  origin,  as  scurvy  is  otherwise  apt  to  make  its 
appearance.  It  is  generally  thought  that  scurvy  is  due 
principally  to  deficiency  of  fresh  vegetables,  but  a  few 
years  ago  an  antarctic  expedition  was  saved  from  disas- 
ter from  this  disease  by  the  addition  to  the  diet  of  fresh 
penguin  meat,  and  numerous  other  instances  indicate 
that  fresh  meat  may  be  as  efficient  as  fresh  vegetables 
in  preventing  or  curing  it. 

Because  of  the  necessity  of  greater  bodily  heat-pro- 
duction in  the  arctics,  more  food  is  required,  and,  as 
meat  and  fat  give  rise  to  more  heat  during  their  oxi- 
dation, and  as  they  are  also  more  readily  obtained,  it  is 
in  them  that  the  increase  should  be  made.  This  need 
is  recognized  by  the  government,  and  is  met  by  an 
increase  in  the  ration  for  troops  serving  in  Alaska. 
Where  game  or  fish  are  obtainable  they  should  be  used 
to  supplement  the  ration.  The  methods  of  preparing 
the  food  are  not  essentially  different  from  those  used 
elsewhere.  Foods  should  be  served  hot,  and  the  heat  of 
the  body  so  conserved. 

Alcohol  should  not  be  used  in  the  arctics  except  as  a 
drug,  as  it  increases  heat-radiation  and  loss. 
Particular  care  should  be  taken  that  it  is 
not  used  during   the  period  of  exposure   to  cold,  as 


134    THE   RECRUIT  AND  HIS  ENVIRONMENT 

that  is  the  time  when  loss  of  heat  is  to  be  especially 
avoided.  If  used  at  all,  it  should  be  after  the  period  of 
exposure,  when  the  body  is  chilled  and  the  surround- 
ings warm  and  comfortable.  In  such  circumstances  it 
may  be  of  considerable  value,  but  its  routine  use  should 
not  be  practiced. 

Fur,  feathers,  and  wool  as  conservators  of  heat,  and 
canvas  and  leather  as  protection  from  wind,  constitute 
the  main  clothing-supply  and  bodily  pro- 
°  tection  in  the  arctics.  Fur,  leather,  and 
canvas,  with  the  exception  of  shoes,  are  for  use  out-of- 
doors  only,  wool  for  general  wear  both  indoors  and  out, 
while  feathers  or  down  are  used  in  bedding.  Extreme 
cold  is  nearly  always  dry,  and  may  therefore  cause  less 
suffering  than  higher  temperatures  when  the  air  is 
moist.  Wind  of  course  greatly  increases  the  suffering 
and  the  danger  from  either  dry  or  wet  cold.  The  reason 
that  fur,  feathers,  and  wool  make  such  warm  clothing  is 
twofold  ;  they  are  themselves  poor  conductors  of  heat, 
and  they  contain  in  their  interstices  a  large  amount  of 
air,  another  poor  conductor.  For  the  latter  reason  a 
multiplicity  of  light  garments  is  warmer  than  the  same 
amount  of  material  woven  into  one  heavy  garment,  and 
cotton  or  silk  wadding  may  be  used  also  with  good  re- 
sults. It  is  because  they  prevent  the  displacement  of 
the  warmed  non-conducting  layer  of  air  within  the 
clothing  that  leather  or  close-woven  canvas  affords  such 
excellent  protection  against  wind. 

Fur  caps  and  gloves,  blanket-lined  canvas  boots,  can- 
vas overcoats  lined  with  blanket  or  sheepskin,  woolen 
outer  and  under  clothing,  woolen  socks,  oiled  shoes,  felt 
overshoes,  and  canvas  leggings  are  issued  for  very  cold 
service,  and  in  far  northern  posts  buffalo  coats  are  still 


HYGIENE  OF   HOT  AND  COLD  CLIMATES    135 

furnished  for  use  by  men  on  guard.  By  proper  use,  these 
articles  can  be  made  to  furnish  adequate  protection 
against  any  cold  that  is  likely  to  be  encountered.  The 
parts  most  apt  to  suffer  from  cold  are  those  most  ex- 
posed and  having  the  weakest  circulation,  such  as  the 
nose  and  cheeks,  the  ears,  hands,  and  feet.  The  fur  cap 
protects  the  head  and  ears,  but  not  the  neck  and  face. 
It  should  therefore  be  used  with  the  overcoat  collar 
turned  up,  or  with  the  hood  of  the  coat,  in  very  cold 
weather.  The  blanket-lined  canvas  hood  covers  the  neck 
and  part  of  the  face  and  therefore  affords  better  pro- 
tection. A  veil  or  a  strip  of  cloth  may  also  be  worn 
across  the  lower  part  of  the  face  if  necessary.  The  fur 
gloves  adequately  protect  the  hands  except  in  the  most 
extreme  cold  or  in  cases  of  long  exposure.  If  necessary, 
woolen  gloves  may  be  worn  beneath  them.  When,  in 
spite  of  them,  the  hands  become  numb  and  cold,  they 
should  be  beaten  or  exercised  to  warm  them.  For  work 
not  requiring  the  use  of  individual  fingers,  woolen  mit- 
tens under  canvas  afford  good  protection  for  the  hands. 
Care  should  be  exercised  about  removing  the  warm 
hand  from  its  fflove  to  do  delicate  work  in  the  cold.  A 
soldier  has  been  known  to  have  both  hands  frost-bitten 
because  he  removed  his  gloves  in  the  wind  and  in  a 
temperature  of  40°  F.  long  enough  to  adjust  his  saddle. 
The  feet  are  easily  kept  warm  during  walking  if  the 
government  issues  of  footwear  are  properly  used  ;  but 
when  men  are  riding  and  not  using  the  feet,  or  when 
snowshoeing  and  the  feet  are  bound  so  tightly  that  the 
circulation  is  interfered  with,  the  problem  is  more  diffi- 
cult. Except  in  wet  weather,  the  foot-covering  should 
not  be  impermeable,  as  the  feet  when  comfortably 
warm  are  apt  to  perspire,  and  such  a  covering  as  a 


136    THE   RECRUIT  AND  HIS   ENVIRONMENT 

rubber  shoe  causes  the  perspiration  to  condense  against 
it  and  to  be  frozen  there,  so  that  the  foot  is  ahnost  or 
actually  in  contact  with  ice.  An  oiled  shoe  is  less 
objectionable,  as  it  does  permit  the  vapor  to  escape, 
in  part  at  least.  In  very  dry  cold,  however,  a  felt  shoe, 
or  two  or  more  pairs  of  woolen  socks  with  canvas  or 
soft  leather  moccasins,  may  be  better  still.  Fur-lined 
boots  or  stockings  are  very  warm.  As  free  circulation 
of  the  blood  is  a  necessity  in  the  prevention  of  frost- 
bite, the  feet  should  not  be  bound  any  tighter  than  the 
absolute  requirements  of  the  work  demand,  and  the 
circulation  should  be  stimulated  by  rubbing  and  knead- 
ing as  opportunity  permits.  Wet  feet  should  of  course 
be  dried  and  dry  coverings  put  on  them  as  soon  as 
possible.  Should  frost-bite  occur,  it  is  important  to  re- 
member that  serious  results  are  less  likely  to  follow  if 
the  part  is  thawed  and  the  circulation  restored  gradu- 
ally, the  beginning  being  made  by  friction  with  snow  or 
cold  water  until  the  pallor  and  hardness  have  disap- 
peared, and  cooling  applications  being  then  applied,  or 
the  part  left  exposed  to  cool  air  which  is  very  gradually 
warmed.  A  healthy  and  well-fed  state  of  body  are  im- 
portant in  preventing  freezing,  and  of  course  over-ex- 
posure on  guard  or  otherwise  is  to  be  prevented  if 
possible.  Fatal  freezing  is  preceded  by  languor,  dull- 
ness, sleepiness,  or  stupidity,  and  men  should  not  yield 
to  sleep  when  very  cold. 

This  is  a  form  of  blindness  due  to  exposure  to  the 
glare  of  bright  sunshine  on  snow.  It  is  usu- 
ally  due  to  spasm  of  the  lids  and  such  sensi- 
tiveness to  the  lio^ht  that  the  eyes  cannot  be 
kept  open.  The  results  may  be  very  serious, 
and  care  should  be  used  to  prevent  the  trouble.  Prob- 


HYGIENE  OF   HOT  AND  COLD  CLIMATES     137 

ably  the  most  effective  measure  when  exposure  is  not 
avoidable  is  the  use  of  "  snow  eyes,"  or  wooden  specta- 
cles with  narrow  slit-like  openings  through  which  vision 
is  possible.  Dark  goggles  are  less  protective,  and  have 
the  additioual  disadvantage  that  they  usually  bring 
metal  into  contact  with  the  skin  and  may  thus  cause 
freezing.  Metal  parts  should  be  wrapped  or  covered 
with  wool  or  fur.  The  practice  of  marching  in  close 
column  and  each  man  keeping  his  eyes  fixed  on  the  back 
of  the  man  in  front  of  him,  the  leading  men  falling  to 
the  rear  of  the  column  as  their  eyes  tire,  is  also  helpful 
in  preventing  it. 


PART  II 

THE  CAUSES  OF  DISEASE 

"  He  discovereth  deep  things  out  of  darkness,  and  bringeth  out  to 
light  the  shadow  0/ death," 

Job  12 :  22. 


CHAPTER  VIII 

THE   REMOTE   OR  PREDISPOSING  CAUSES    OF  DISEASE 

For  our  purposes  it  may  be  assumed  that  most  of  the 
diseases  with  which  we  are  concerned  are  due  to  animal 
or  vegetable  parasites  ;  but  not  every  man  exposed  to 
infection  by  such  parasites  contracts  the  diseases  caused 
by  them.  A  special  predisposition  or  liability  is  neces- 
sary, otherwise  everybody  would  have  tuberculosis,  the 
entire  army  at  Chickamauga  in  1898  would  have  had 
typhoid  fever,  and  all  physicians  would  die  of  infectious 
diseases  within  a  short  time  after  entering  upon  their 
profession.  This  matter  of  liability  or  immunity  to 
diseases  is  one  of  the  most  interesting,  complicated, 
and  important  in  the  whole  realm  of  medicine,  and 
many  of  the  world's  greatest  thinkers  and  investi- 
gators find  it  worthy  of  their  highest  efforts  and  con- 
stant attention.  It  is  the  purpose  of  this  chapter  to  deal 
with  these  questions  in  some  elementary  aspects  that 
should  be  known  by  the  company  officer,  in  a  practical 
and  simple  way,  without  technicalities. 

One  of  the  most  important  of  the  factors  concerned 
in  predisposition  to  disease  is  heredity.    Every    man 
inherits  from  his  ancestry  something  that 
renders  him  liable  to  tuberculosis,  but  im-  ^ 

mune  to  rinderpest  and  chicken-cholera.  He  possesses 
in  a  degree  not  possessed  by  any  other  known  creature 
a  liability  to  malaria,  syphilis,  gonorrhoja,  yellow  fever, 
cholera,  smallpox,  and  other  diseases,  while  he  shares 
with  many  other  animals  his  susceptibility  to  tubercu- 
losis, suppuration,  plague,  and  anthrax,  and  at  the  same 


142  THE   CAUSES  OF  DISEASE 

time  he  is  not  at  all  subject  to  some  diseases  that  are 
very  fatal  to  his  domestic  animals. 

In  addition  to  its  influence  in  this  general  sense,  he- 
redity has  long  been  credited  with  great  influence  in 
predisposing  certain  families  or  individuals  to  certain 
diseases.  Consumption  was  long  looked  upon  as  a  hered- 
itary disease,  but,  with  our  more  complete  knowledge 
as  to  its  nature,  the  tendency  is  now  to  regard  its  ap- 
pearance and  persistence  in  families  as  an  evidence  of 
familial  contagion  rather  than  of  heredity.  In  the  case 
of  cancer,  another  disease  prone  to  "  run  in  families," 
the  same  explanation  is  now  frequently  advanced, 
though  no  germ-cause  is  known  for  the  disease.  The 
influence"  of  heredity,  though  still  considered  weighty, 
is  not  now  so  much  emphasized  as  formerly  as  a 
cause  of  insanity.  In  all  these  diseases,  however,  it  is 
still  contended  that  a  predisposition,  a  type  of  tissues 
endowed  with  resisting  powers  below  the  normal,  is  in- 
herited, even  if  the  disease  has  an  extraneous  cause. 
Disease  can  at  times  be  born  with  the  child,  and  not 
manifest  itself  until  later,  the  actual  disease  germ 
being  present  in  the  body  all  the  time.  Syphilis  is 
the  ailment  most  often  showing  this.  Other  diseases, 
such  as  typhoid  and  smallpox,  may  be  contracted  in  the 
uterus,  and  the  child  may  be  born  sick.  It  is  probable 
that  sometimes  disease  may  be  suffered  and  recovered 
from  in  the  mother's  womb,  and  the  attack  confer  im- 
munity through  later  life. 

Certain  persons  appear  to  possess  all  their  lives  an 
immunity  to  certain  diseases,  never  contracting  them  in 
spite  of  frequent  and  direct  exposure.  * 

^  Captain  C.  F.  Craig  and  the  writer  were  quite  unable  to  infect  cer- 
tain individuals,  who  volunteered  for  the  purpose,  with  dengue,  using 
methods  usually  successful  and  injecting  doses  of  infected  blood  many 
times  as  great  as  would  be  received  in  natural  infections. 


PREDISPOSING  CAUSES   OF   DISEASE     143 

Certain  nervous  affections  have  no  known  cause  but 
heredity,  the  disease  appearing  in  the  affected  family 
with  great  regularity.  "Bleeders,"  persons  who  bleed 
excessively  or  fatally  from  very  trifling  injuries,  in  most 
instances  inherit  the  tendency,  and  in  a  curious  way,  as  it 
usually  descends  only  through  females  to  manifest  itself 
in  males.  The  drink  habit  is  often  spoken  of  as  inher- 
ited, but  this  is  probably  not  the  case.  An  unstable 
nervous  system,  which  allows  its  possessor  to  fall  more 
readily  a  victim  to  drink  or  other  excesses,  is  inherited. 
It  is  common  observation  that  types  of  body  are  in- 
herited, that  children  look  and  are  built  like  their 
parents,  and  it  is  but  natural  that  they  should  be  pre- 
disposed to  the  same  diseases,  so  far  as  bodily  conforma- 
tion exercises  any  influence. 

That  this  does  exercise  an  influence  is  indicated  by 
the  table  quoted  on  page  5,  as  well  as  by  popular 
belief.    The  common  remark  that  such  a 
man  looks  as  though  he  might  have  apo-        -^^ 
plexy  any  day,  or  such  another  man  will  ^ 

probably  die  of  consumption,  are  based  on  facts  long 
noted  by  physicians  and  the  public.  It  is  partly  for  the 
purpose  of  eliminating  persons  so  predisposed  to  disease 
that  the  government  demands  not  only  that  each  man 
shall  be  in  good  health  at  the  time  of  his  enlistment, 
but  that  he  shall  also  conform  to  certain  standards  not 
having  much  bearing  on  his  present  efficiency. 

Certain  diseases  are  known  generally  as  those  of 
childhood,  as  they  are  so  rarely  seen  in  persons  beyond 
that  age.  Scarlet  fever,  measles,  whooping- 
cough,   and  diphtheria   may   all  occur  at         ^ 
other  stages  of  life,  but  it  is  with  ever-decreasing  fre- 
quency that  they  do  so,  and  the  phrase  is,  in  general, 


144  THE   CAUSES   OF   DISEASE 

correct.  On  the  other  hand,  cancer,  apoplexy,  cataract, 
and  several  other  troubles  are  so  nearly  confined  to 
aged  persons  that  they  may  be  called  diseases  of  old 
age.  Certain  infections  are  seen  principally  in  early 
adult  life,  so  that  it  is  the  young  soldier  that  usually 
shows  them  in  the  military  service.  Among  them  we 
may  mention  typhoid,  gonoi'rhoea,  syphilis.  The  ques- 
tion of  age  is  related  to  that  of  recklessness  and  folly, 
and  it  is  partly  for  this  reason  that  the  young  are  in 
general  more  disposed  than  the  old  to  infectious  dis- 
eases. The  prospects  of  recovery  from  an  illness  are 
also  influenced  by  age.  Pneumonia  and  injuries  are 
much  more  serious  in  an  old  than  in  a  young  man.  On 
the  other  hand,  diabetes  and  epilepsy  are  not  usually 
so  serious  in  elderly  persons  as  in  children. 

Certain  persons  are  born  with  peculiarities  of  person 
that  render  them  particularly  liable  to  certain  diseases, 
and  no  adequate  explanation  can  be  offered 
for  them.    Some  persons  cannot  eat  fish, 
others  strawberries,  others  eggs ;  and  if  any 
^  of  these  overcomes  his  dislike  and  forces 

himself  to  eat  of  the  forbidden  thing,  he  is  made  sick, 
possibly  dangerously  so.  A  large  number  of  persons  are 
born  with  such  a  susceptibility  to  the  effects  of  certain 
pollens  that  they  have  to  leave  their  homes  when  these 
pollens  are  ripe,  or  suffer  from  hay  fever.  Some  men 
suffer  from  asthma  if  they  go  about  a  stable  or  ride  be- 
behind  a  horse,  others  are  made  sick  or  faint  by  the 
presence  of  a  cat  or  the  odor  of  its  urine.  Of  two  healthy 
men,  one  may  suffer  great  discomfort  after  taking  a 
tenth  of  a  grain  of  iodide  of  potash,  while  the  other 
can  take  three  hundred  times  as  much  and  not  suffer 
at  all.    It  is  not  impossible  that  similar  peculiarities 


PREDISPOSING   CAUSES   OF   DISEASE     145 

influence  the  development  and  course  of  infectious 
diseases. 

Worry,  fear,  and  homesickness  strongly  predispose 
to,  if  they  do  not  actually  cause,  mental  and  nervous 
diseases.  They  also  appear  to  predispose  to 
infectious  diseases,  possibly  by  lowering  the 
general  resisting  powers  and  influencing  the 
circulation. 

The  aphorisms  of  all  languages  recognize  the  value 
of  training  in  almost  any  occupation  or  pursuit  in  life. 
Military  authorities  recognize  it  by  the  fact     ^     .    . 
that  they  require  the  soldier  to  spend  years  ° 

in  training  for  an  emergency  that  may  never  arise,  or 
that,  having  arisen,  may  last  but  a  day  or  an  hour.  It  is 
not  less  valuable  in  sanitary  matters  than  elsewhere. 
The  child  or  the  man  who  is  trained  to  reason,  to  obey, 
and  to  conduct  himself  properly,  is  in  much  less  danger 
from  infectious  diseases  in  camp  or  elsewhere  than  is 
the  reckless,  disobedient,  or  headstrong  individual  who 
knows  no  law  but  his  own  will  and  appetite.  It  is  the 
latter  who  drinks  bad  water,  eats  poor  food,  contracts 
venereal  disease  at  each  opportunity,  urinates  and 
defecates  in  forbidden  places,  avoids  vaccination,  seeks 
alcoholic  indulgence,  sleeps  without  his  mosquito-net, 
spits  on  the  floor,  and  is  otherwise  a  source  of  much 
worry  and  mischief.  It  is  because  of  this  lack  of  train- 
ing in  hygiene  that  recruits  are  so  apt  to  become  sick 
when  brought  into  camp,  and,  what  is  worse,  to  scatter 
their  sickness  in  all  directions.  It  is  this  same  lack  of 
training  that  constitutes  the  greatest  weakness  and  the 
greatest  evil  of  our  military  system  to-day,  and  gives 
origin  to  the  fear  that  when  we  again  mobilize  an  army 
of  a  quarter  or  a  half  million  of  men,  —  more  than  the 


146  THE   CAUSES   OF   DISEASE 

regular  medical  staff  can  oversee,  —  the  conditions  of 
1898  may  be  repeated. 

Lack  of  training  on  the  part  of  troops  is  the  most 
important  predisposing  cause  of  disease  in  armies.  It 
is  the  duty  of  all  officers,  of  whatever  rank  or  branch 
of  the  service,  to  endeavor  to  overcome  this  defect,  for 
which  they  are  mainly  responsible.  The  fact  that  a  man 
is  ignorant  or  headstrong  at  the  time  of  his  enlistment 
does  not  justify  his  being  so  a  year  or  three  years  later. 
Medical  officers  should  be  required  to  give  lectures  or 
other  instruction,  but  the  company  officer  should  see 
that  example  and  wise  precept  are  so  constantly  before 
the  minds  of  his  men  that  hygienic  living  becomes  a 
matter  of  habit. 

Aside  from  habit  in  the  large  sense  just  used,  many 
small  and  unimportant  personal  customs  have  an  influ- 
ence  in  predisposing  to  disease.  Eating  raw 
meat  predisposes  to  infestation  with  tri- 
chinaB  or  with  tapeworms,  carelessness  in  hand-washing 
increases  the  liability  to  many  infections  and  poisonings. 
The  habit  of  going  barefooted  may  be  of  very  great 
importance  in  predisposing  to  plague  and  hookworm 
disease.  Careless  habits  in  the  disposal  of  waste  are 
responsible  for  so  many  sanitary  ills  as  to  make  it  evi- 
dent that  the  main  purpose  of  sanitary  training  is  the 
establishment  of  proper  habits. 

The  influence  of  race  as  a  predisposing  factor  of  dis- 
ease is  closely  related  to  that  of  heredity,  habits,  and 
_  environment,  but  race  in  itself   exercises 

some  influence.  The  reason  for  this  is  not 
always  known,  but  in  some  instances  it  is  probably  due 
to  long  racial  exposure  to  certain  diseases,  whereby 
only  the  more  resistant  strains  or  families  survive.  At 


PREDISPOSING  CAUSES   OF   DISEASE    147 

other  times  it  is  probably  the  case  that  the  disease  in 
question  may  be  uniformly  incurred  in  childhood,  and 
so  confer  protection  through  later  life.  Thus,  the  ques- 
tion has  been  raised  whether  the  present  repression  of 
yellow  fever  will  not  permit  the  growth  of  a  generation 
of  Cubans  having  no  natural  immunity  to  the  disease. 
Whatever  the  reason,  Cubans  and  West  African  natives 
are  less  susceptible  to  yellow  fever  than  Americans  and 
Europeans.  Jews  are  especially  subject  to  diabetes, 
and  negroes  are  much  more  apt  than  other  peoples  to 
suffer  from  keloid,  a  form  of  tumor  resembling  over- 
grown scars. 

Exposure  to  inclemencies  of  weather  acts  as  a  predis- 
posing cause  to  numerous  diseases.  Tonsillitis,  pneumo- 
nia, rheumatism,  and  influenza  are  all  germ- 
diseases,  yet  the  frequency  with  which  an  ^ 

attack  of  any  of  these  is  ascribed  to  wet- 
ting or  cold  shows  that  these  influences  are  not  with- 
out effect.  The  germs  causing  pneumonia,  diphtheria, 
spinal  meningitis,  and  tonsillitis  may  be  present  in  the 
mouths  or  noses  of  healthy  people  and  produce  no  symp- 
toms, yet  after  exposure  the  person  may  sicken.  In  a 
similar  manner  a  person  may  carry  the  organisms  of 
malaria  or  dysentery,  and  only  become  conscious  that 
he  is  ill  after  a  wetting  or  chilling. 

Injury  predisposes  to  very  many  diseases.  Pneu- 
monia, meningitis,  and  typhoid,  of  general  diseases, 
may  follow  injuries  in  such  a  manner  as  -  . 
to  appear  related  to  them.  Abscesses,  kid- 
ney and  liver  troubles,  and  tumors  may  follow  injuries 
that  do  not  break  the  skin,  while  anthrax,  erysipelas, 
most  suppurations,  "  blood-poisoning,"  hospital  gan- 
grene, lockjaw,  hydrophobia,  and  some  other  affections 


148  THE   CAUSES   OF   DISEASE 

are  preceded  by  breaks  in  the  skin  in  nearly  all  in- 
stances, though  these  may  be  so  small  as  not  to  be 
noticed  at  the  time.  It  is  through  the  wounds  that  the 
disease-producing  organisms  gain  entrance  to  the  body. 
In  the  strict  sense  it  is  also  through  wounds  —  insect 
bites  —  that  malaria,  yellow  fever,  plague,  and  sleeping 
sickness  are  transmitted.  The  great  class  of  suppura- 
tions, however,  is  the  principal  diseases  following  in- 
jury, and  the  proper  use  of  the  first-aid  packet  for  the 
purpose  of  preventing  them  has  almost  done  away  with 
one  of  the  greatest  horrors  of  war. 

Injury  may  also  act  as  a  means  of  diffusing  and  gen- 
eralizing an  affection  previously  isolated  and  relatively 
harmless.  It  may  rupture  an  abscess  due  to  appendi- 
citis, and  so  give  rise  to  general  and  fatal  peritonitis, 
or  it  may  loosen  the  infected  clot  in  an  inflamed  vein, 
and  cause  acute  general  "  blood-poisoning." 

As  is  shown  in  Part  I  of  this  book,  the  soldier's 
environment  includes  so  much  that  it  must  exercise  an 
influence    in  predisposing  him  to,  or  pro- 
tecting him  against,  nearly  all  sorts  of  dis- 
eases. It  is  so  large  a  matter  that  it  cannot 
be  adequately  mentioned  in  a  paragraph,  and  the  whole 
subject  of  hygiene  touches  on  it.    The  consideration  of 
some  phases  of  it  occupies  the  remainder  of  this  chapter. 
There  are  quite  a  number  of  "  occupation  diseases," 
so  called  because  their  development  depends  on  injury 
due  to  the  employment  of  the  individuals. 
..        ^         Among  such  diseases   may  be   mentioned 
writer's  cramp,  painter's    colic,    chimney- 
sweep's scrotum,  housemaid's  knee,  and  many  others. 
During  and  after  the   Civil  War  a  certain   type  of 
dilated  and  irritable  heart  was  known  as  soldier's  heart. 


PREDISPOSING  CAUSES   OF  DISEASE    149 

and  iu  the  stress  of  a  hard  campaign  many  more  cases 
may  develop.  In  the  early  months  of  1899,  when  the 
State  troops  were  doing  much  hard  marching  in  the 
Philippines,  many  such  cases  were  seen.  Occupation 
has  a  great  effect,  however,  in  other  and  less  obvious 
ways.  Thus  it  may  expose  a  soldier  to  mosquito  bites 
and  so  predispose  him  to  malaria,  yellow  fever,  or 
dengue;  it  may  put  him  on  guard  in  a  prison,  where 
he  will  contract  typhus  or  relapsing  fever,  Men  work- 
ing about  stables  are  more  apt  than  others  to  suffer 
from  lockjaw  after  wounds,  as  the  germ  occurs  in 
horse-manure.  Occupations  involving  the  breathing  of 
much  dust,  such  as  marble-cutting,  scissors-grinding, 
and  some  weaving,  predispose  to  tuberculosis.  Seden- 
tary occupations  may  impair  digestion,  allow  muscles 
to  atrophy,  and  cause  hemorrhoids.  Callings  involving 
great  strains  or  exertion  predispose  to  diseases  of  the 
heart  and  blood-vessels.  It  is  stated  that  the  majority 
of  Japanese  jinricksha  men  are  dead  or  invalids  from 
circulatory  diseases  before  they  attain  the  age  of  forty. 
Occupations  causing  much  worry  or  nervous  strain 
predispose  to  nervous  exhaustion.  Overwork  in  almost 
any  calling  may  predispose  to  disease,  either  by  lower- 
ing or  exhausting  the  general  resisting  powers  of  the 
body,  or  by  exhausting  the  nervous  supply. 

The  quality  of  the  air-supply  is  very  important  as 
predisposing  to  disease,  by  its  temperature,  dryness,  or 
purity.  Too  great  heat,  especially  if  moist,  . 
causes  much  discomfort  and  may  result  in 
heat-exhaustion,  heat-stroke,  and  death.  Kooms  that 
are  too  hot  cause  the  men  to  sweat  and  to  expose  them- 
selves unduly  to  cold  or  draughts,  which  may  result  in 
congestions  of  the  lungs  or  kidneys.   Rooms  that  are 


150  THE  CAUSES   OF   DISEASE 

too  cold  allow  the  body  to  become  chilled  on  the  sur- 
face and  congested  internally,  making  easy  the  devel- 
opment of  coughs,  sore  throat,  and  other  troubles.  In 
barracks,  however,  such  troubles  are  usually  more  closely 
related  to  foulness  and  contamination  of  the  air  than 
to  its  temperature.  One  case  of  sore  throat  in  a  squad- 
room  may  suffice  to  contaminate  the  air  and  expose 
every  man  in  the  room  to  disease  if  the  ventilation  is 
poor.  This  condition  is  aggravated  with  every  increase 
in  crowding.  Carbon  dioxide  and  other  waste-products 
of  the  body  may  also  make  the  air  poisonous  without 
considering  infection. 

Foggy  or  damp  air  predisposes  somewhat  to  rheu- 
matism. That  which  is  too  dry  causes  dryness  and 
irritation  of  the  respiratory  surfaces.  Dusty  air  intro- 
duces many  infections,  among  them  tuberculosis,  and 
it  is  for  this  reason  that  spitting  on  floors  or  streets  is 
very  dangerous.  The  spit  dries  and  is  pulverized,  and 
eventually  becomes  dust,  in  which  condition  it  may  be 
blown  or  inhaled  into  sound  noses  or  throats,  carrying 
with  it  the  disease-producing  germs.  Dust-laden  air  is 
responsible  for  many  more  "  colds  "  than  is  cold  itself. 

The  use  of  contaminated  water  predisposes,  of  course, 
to  water-borne  infections.  In  addition,  the  use  of  very 
hard  water  or  of  water  containing  chemi- 
cals may  so  disturb  the  digestive  organs  as 
to  make  infection  easier.  Excessive  water-drinking  dis- 
turbs the  digestion  and  causes  unnecessarily  profuse 
sweating  and  urination ;  deficiency  of  it  causes  irrita- 
tion of  the  kidneys  and  bladder,  constipation,  and 
general  insufficiency  of  waste  elimination.  Greater  in- 
sufficiency of  course  causes  direct  suffering  from  thirst. 

Aside  from  the  very  numerous  infections  conveyed 


PREDISPOSING  CAUSES   OF   DISEASE    151 

by  uncooked  or  improperly  cooked  foods,  which  are 
mentioned  at  greater  length  in  other  places, 
the  kind,  amount,  and  preparation  of  the 
articles  used  has  so  great  an  influence  on  health  as  to 
make  the  subjects  of  catering  and  cookery  worthy  of 
the  company  officer's  best  thought.  He  should  learn 
what  foods  are  good,  their  relative  digestibility,  food- 
values,  cost,  and  the  amounts  in  which  they  should  be 
furnished.  The  method  of  preparation  should  be  such 
as  to  make  them  attractive  and  digestible.  The  ration 
forms  an  excellent  basis. 

Excess  of  food  predisposes  to  stomach  and  intestinal 
disorders,  to  gout,  obesity,  vascular  and  kidney  diseases, 
and  to  various  forms  of  auto-intoxication,  or  self-poison- 
ing by  waste  products.  Insufficiency  of  proper  food  leads 
to  weakness,  loss  of  flesh  and  a  lessened  resistance,  that 
renders  infections  more  easy.  Great  epidemics  of  typhus 
and  relapsing  fever  have  followed  famine  and  depriva- 
tion so  many  times  as  to  earn  for  them  the  title  of 
famine  fevers. 

Alcohol  is  the  direct  cause  of  such  diseases  as  delirium 
tremens,  alcoholic  neuritis,  and  gastric  catarrh ;  but  it  is 
also  a  predisposing  cause  of  many  other 
diseases,  —  of  the  blood-vessels,  heart,  kid- 
neys, and  brain.  It  also  predisposes  to  infections,  both 
by  making  its  user  careless  in  regard  to  them  and  by 
lowering  the  resisting  powers.  Drunkards  are  especially 
subject  to  pneumonia,  and  are  also  especially  un- 
favorable subjects  for  that  disease.  The  chronic  gastric 
catarrh  of  the  old  alcoholic  may  make  him  an  easy 
victim  for  cholera  or  typhoid.  Alcohol  predisposes 
to  heat-exhaustion  in  hot  and  to  freezing  in  cold 
climates. 


152  THE  CAUSES  OF   DISEASE 

Insufficient  or  excessive  clothing  may  predispose  to 
disease  as  do  heat  and  cold.  Insufficient  covering  in  the 
tropics  may  lead  to  severe  sunburn,  or,  if 
°  of  the  head  or  spine,  predispose  to  heat- 
stroke. Lack  of  foot-covering  not  only  leads  to  injury 
of  the  feet,  but  predisposes  to  diseases  that  usually  enter 
through  the  skin  of  the  feet,  including  hookworm  dis- 
ease, chiggers,  Guinea  worm,  and  plague.  Insufficient 
clothing  may  also  predispose  to  mosquito-borne  diseases. 
Excessive  clothing  may  predispose  to  heat-stroke,  ex- 
haustion, and  diarrhoea,  and  this  is  especially  true  when 
men  are  turned  out  for  inspection  or  drill  in  too  heavy 
uniforms. 

Warm  baths,  if  followed  by  exposure  or  chilling,  may 
predispose  to  disease,  as  may  cold  ones  in  persons  who 
do  not  react  promptly.  Insufficient  bathing 
°  predisposes  to  skin  diseases,  especially  in 
hot  countries ;  bathing  in  polluted  waters,  to  water- 
borne  infections.  In  addition  to  typhoid,  dysentery, 
cholera,  and  common  intestinal  worms,  there  is  reason 
to  believe  that  schistosomum  disease  —  infestation  with 
a  worm  that  lives  in  the  veins  of  the  liver,  and  causes 
bleeding  and  other  serious  bowel  and  bladder  symp- 
toms —  may  occur  during  bathing,  the  young  parasites 
entering  through  the  skin.  This  disease  is  widespread 
in  Africa,  and  varieties  of  it  are  seen  in  the  West  Indies 
and  the  Philippines,  so  that  it  may  yet  assume  impor- 
tance with  us. 

The  use  of  dirty  water  also  predisposes  to  skin  dis- 
eases, as  noted  in  regard  to  the  oft-bathing  Japanese. 
The  exposure  incident  to  bathing  in  streams  may  in- 
crease the  liability  to  diseases  conveyed  by  mosquitoes 
and  other  insects. 


PREDISPOSING  CAUSES  OF   DISEASE     153 

Natural  sleep  in  proper  amounts  is  an  important 
factor  in  the  prevention  of  disease  ;  the  lack  of  it  causes 
weakness,  exhaustion,  and  depression  that 
render  infection  and  injury  easy  matters.  ° 

Insufficient  sleep  for  a  long  period  of  time  causes  ner- 
vous disorders  and  predisposes  to  insanity.  Sleeping  in 
improper  surroundings  may  greatly  increase  the  liability 
to  disease  through  chilling,  wetting,  exposure  to  mos- 
quito bites,  and  in  other  ways.  Sleeping  in  close  contact 
with  persons  suffering  from  certain  contagious  diseases 
would  strongly  predispose  them,  as  would  sleeping  in 
the  beds  or  clothing  of  such  persons. 

Poor  sanitary  police  is   a  feature  of  poor  military 

training,  and  predisposes  to  all  of  the  epidemic  forms 

of  infectious  diseases.  It  does  this  by  allow-     ^  ,. 

Folics 
ing  infected  dust  and  papers  to  blow  about 

and  pollute  the  air,  by  allowing  soil  and  water  con- 
tamination, by  leaving  or  providing  breeding-places  and 
food  for  flies,  fleas,  mosquitoes,  rats,  and  other  vermin, 
and  by  failure  to  remove  sources  of  infection.  In  these 
ways  it  encourages  the  development  of  typhoid,  cholera, 
dysentery,  yellow  fever,  plague,  pneumonia,  influenza, 
tuberculosis,  and  other  diseases. 

By  attention  to  police  and  general  cleanliness  of 
houses  and  neighborhoods  some  diseases  that  formerly 
occurred  in  great  epidemics  have  been  almost  banished 
from  civilized  countries,  and  even  famine  does  not  bring 
them  forth  as  in  earlier  times.  Typhus  and  relapsing 
fevers  are  striking  examples.  Tuberculosis  and  other 
diseases  have  been  reduced  in  part  by  similar  measures. 

As  the  best  police  is  possible  only  when  all  unite  in 
striving  for  it,  it  is  essential  that  line  officers  and 
enlisted  men  should  become  interested  in  the  sanitary 


154  THE  CAUSES   OF   DISEASE 

importance  of  the  question,  and  should  look  on  good 
policing  as  a  source  of  pride,  comfort,  safety,  and  effi- 
ciency. 

A  poor  camp-site  may  constitute  a  predisposing  cause 
to  many  kinds  of  disease.  It  may  expose  the  men  to  fog, 
unnecessary  dampness,  wind  and  cold,  or  to 
'^~  dust  and  heat,  to  mosquitoes,  flies,  fleas,  bad 
water,  or  contaminated  soil,  and  through 
these  factors  promote  the  development  of  the  worst 
camp-diseases.  While  it  is  highly  desirable,  therefore, 
to  select  as  good  camp-sites  as  can  be  obtained,  it  must 
ever  be  borne  in  mind  that  proper  sanitary  precautions 
may  nullify  the  evil  effects  of  a  bad  site,  and  that 
neglect  of  them  is  almost  certain  to  destroy  the  value 
of  a  good  one.  Polluted  sites,  those  that  have  been 
much  used  by  troops,  and  those  that  expose  the  men  to 
bad  water  and  disease-bearing  insects  are  particularly 
to  be  avoided,  as  these  factors  predispose  so  strongly 
to  various  diseases  that  only  the  best  trained  and  disci- 
plined troops  may  come  off  unharmed. 

Practically  every  case  of  infectious  disease  is  derived 
from  some  other  one,  and  it  is  therefore  obvious  that 
^  the  existence  of  one  case  constitutes  a  f  ac- 

tor  predisposing  to  more.  One  man  with 
typhoid,  cholera,  smallpox,  or  plague,  m  a 
camp,  constitutes  a  danger  to  the  entire  command,  and 
this  fact  is  so  well  recognized  in  these  and  other  dis- 
eases that  it  forms  the  basis  of  the  entire  system  of 
quarantine  and  isolation.  The  origin  of  individual  cases 
of  infectious  diseases  may  be  difficult  to  trace,  the  ty- 
phoid-carrier, the  unsuspected  syphilitic,  or  the  man 
with  a  slight  diphtheria,  not  even  realizing  that  he  is 
sick,  and  unknowingly  spreading  disease  broadcast.  One 


PREDISPOSING  CAUSES  OF   DISEASE     155 

disease  may  predispose  to  the  development  of  another 
or  to  new  manifestations  that  are  spoken  of  as  new 
diseases.  Thus  blood-poisoning,  gonorrhoea,  typhoid, 
and,  more  particularly,  rheumatism,  predispose  to  val- 
vular heart-disease,  syphilis  to  certain  affections  of  the 
nervous  system,  diphtheria  to  varying  forms  of  paraly- 
sis, dysentery  to  liver  abscess.  Other  instances  might  be 
detailed  in  considerable  numbers,  but  enough  has  been 
said  to  indicate  that  disease  is  a  factor  that  may  pre- 
dispose to  other  diseases. 


CHAPTER  IX 

THE   IMMEDIATE   OR   EXCITING   CAUSES    OF    DISEASE 

The  immediate  or  exciting  causes  of  some  diseases, 
among  which  may  be  mentioned  such  important  ones  as 
scarlet  fever,  measles,  yellow  fever,  and  typhus,  are  un- 
known, but  those  that  are  known  are  so  numerous  and 
of  such  varied  character  that  they  could  not  possibly 
be  discussed  in  this  chapter,  even  if  it  were  desirable 
that  they  should  be.  We  will  therefore  omit  all  discus- 
sion of  the  causes  of  large  and  important  groups  of 
diseases,  and  consider  only  briefly  the  various  classes 
of  disease-producing  factors  which  it  seems  it  would 
be  interesting  or  profitable  for  the  company  officer  to 
know.  Numerous  as  they  are,  such  factors  may  be 
gathered  into  a  few  groups. 

Of  these  groups,  the  first  to  be  considered  is  that  of 
mechanical  causes,  and,  of  such,  traumatism  or  violence 
is  probably  the  most  important.  Like  the 
other  components  of  this  group,  it  may  pre- 
dispose to  disease,  but  it  is  also  the  direct 
or  exciting  cause  of  many  ills,  among  which  we  may 
class  practically  all  varieties  and  instances  of  wounds, 
from  the  slightest  abi-asion  to  the  most  extensive  shell- 
wound,  fractures,  dislocations,  and  bruises.  Concussion, 
laceration,  or  rupture  of  internal  organs,  such  as  the 
brain,  spinal  cord,  liver,  kidneys,  stomach,  intestines, 
or  bladder,  may  result  from  blows  or  other  injuries  that 
cause  no  break  in  the  skin,  or  even,  in  rare  instances, 
leave  no  external  mark.  At  times  the  violence  may  be 


EXCITING  CAUSES   OF   DISEASE         157 

slight  in  degree,  and  apparently  out  of  all  proportion 
to  the  resulting  damage.  Thus,  a  relatively  slight  blow 
on  the  chin  may  be  so  directly  transmitted  to  the  brain, 
and  so  jar  and  shake  it,  as  to  cause  immediate  and 
deep  unconsciousness ;  or  a  blow  over  a  distended 
stomach  or  bladder  may  rupture  it  and  cause  death,  to 
the  great  surprise  of  all  witnesses.  Or  the  evil  effects 
of  the  injury  may  not  be  manifested  at  once.  A  knee 
or  hip,  for  instance,  may  be  injured  and  give  rise  to  no 
symptoms  at  the  time,  but  later  cause  prolonged  suffer- 
ing or  lameness  ;  or  a  man  may  receive  a  severe  blow 
on  the  head  or  the  abdomen,  and  continue  at  his  work 
all  day,  yet  he  may  have  received  an  injury  from  which 
he  will  die  in  a  few  days.  Officers  should,  therefore, 
exercise  much  care  and  forbearance  before  they  pro- 
nounce a  man  a  malingerer  because  some  accident  from 
which  he  suffered  appeared  trivial  or  harmless.  Vio- 
lence may  be  so  transmitted  as  to  manifest  its  effects 
on  a  distant  part.  Thus  a  man  may  fall  from  a  height 
and  land  on  his  feet,  and  yet  fractui-e  his  skull ;  or  he 
may  fall  on  his  hands  and  fracture  his  collar-bone  ;  or 
he  may  receive  a  blow  on  the  right  side  of  the  head 
and  suffer  a  laceration  of  the  left  side  of  the  brain.  As 
the  manifestations  of  violence  may  be  almost  infinite 
in  variety,  so  may  its  effects.  Pressitre  may  also  cause 
disease  in  a  variety  of  ways.  Applied  to  the  feet  it 
may  cause  deformity,  bunions,  or  corns ;  to  the  waist, 
displacement  of  internal  organs  ;  to  a  nerve,  as  by  a 
bullet  or  a  bone-fragment,  paralysis  or  great  pain; 
applied  to  a  blood-vessel,  it  may  cause  ulceration  and 
rupture,  with  fatal  bleeding,  or  it  may  cut  off  the  blood- 
supply  of  the  part  to  which  the  vessel  runs,  and  cause 
gangrene  or  death. 


158  THE  CAUSES  OF   DISEASE 

Heat  and  cold,  besides  predisposing  to  disease,  as 
shown  in  the  preceding  chapter,  may  directly  cause 
injuries  varying  from  the  slight  reddening  of  the  mild- 
est burn  or  chilblain  to  the  loss  of  entire  limbs,  or  of 
life  itself.  They,  as  well  as  violence  and  pressure,  in 
addition  to  the  immediate  damage  done,  may  cause  life- 
long suffering  or  deformity,  from  the  formation  or 
contraction  of  large  scars,  or  by  means  of  secondary 
infections. 

Increase  or  diminution  of  at7nosj)heric  pressure  may 
cause  disease  or  death,  the  former  in  divers  or  caisson- 
workers,  the  latter  in  mountain-climbers  or  balloonists. 
In  the  case  of  increased  pressure,  the  trouble  most 
often  comes  from  too  sudden  return  to  normal  pressure, 
which  allows  the  liberation  of  nitrogen  gas  in  the  blood. 

Electricity  may  cause  disorders  varying  from  slight 
pain  or  nervous  disturbance  to  deep  burning  or  sudden 
death.  Mechanical  injuries  that  are  not  usually  thought 
of  as  such  are  exemplified  by  the  rashes  or  irritations 
due  to  handling  or  contact  with  some  caterjnllars  or 
moths,  and  are  caused  by  the  introduction  and  retention 
in  the  skin  of  the  minute  barbed  hairs  that  partly  cover 
the  creatures. 

The  group  of  chemicals  that  cause  disease  or  death 

is  very  large  and  embraces  practically  all  poisons.  They 

.  may  occur  in  any  form,  gaseous,  liquid,  or 

solid,  and  may  enter  the  body  in  any  way, 

as  by  inhalation,  by  mouth,  by  the  rectum,  through  the 

skin,  or  through  wounds. 

Gaseous  poisons  usually  enter  the  system  by  inhala- 
tion. Those  most  commonly  causing  trouble  are  carbon 
dioxide,  water  gas,  coal  or  charcoal  gas,  or  carbon 
monoxide.    These  and  other  gases  may  produce  death 


EXCITING   CAUSES   OF  DISEASE         159 

without  occasioning  great  suffering.  Another  group,  in- 
cluding formalin,  ammonia,  chlorine,  and  sulphurous 
fumes,  cause  marked  irritation  of  the  respiratory  tract 
and  excite  efforts  at  escape,  so  that  they  are,  in  that 
respect,  less  dangerous.  Certain  others,  such  as  some 
compounds  of  arsenic  or  phosphorus,  may  cause  poison- 
ing by  inhalation  in  small  amounts,  and  be  very  diffi- 
cult to  trace.  Chloroform  and  ether  usually,  and  wood- 
alcohol  and  some  other  liquids  occasionally,  enter  the 
body  in  a  vaporous  or  gaseous  form.  Gases  may  produce 
death  in  any  one  of  several  ways :  by  acting  mechan- 
ically to  exclude  oxygen,  and  so  cause  suffocation,  as  in 
the  case  of  nitrogen ;  by  forming  combinations  with  the 
blood  to  prevent  its  taking  up  oxygen,  even  if  it  has 
the  opportunity,  as  in  the  case  of  charcoal  gas ;  by  caus- 
ing paralysis,  or  change  of  nerve-tissue,  as  in  the  case 
of  chloroform  or  wood  alcohol ;  by  causing  such  irri- 
tation of  the  glottis  as  to  close  it  by  swelling,  and  so 
induce  suffocation,  as  does  ammonia. 

Liquid  poisons  may  also  cause  injury  or  death  in  a 
great  variety  of  ways.  The  group  includes  a  large 
number  of  substances.  Some  of  them,  such  as  svlphuric 
and  nitric  acid,  do  injury  by  their  sti'ong  corrosive 
properties ;  others,  as  alcohol,  act  on  the  nerves.  They 
usually  enter  the  body  by  way  of  the  mouth,  but,  as  in 
the  case  of  the  acids,  they  may  act  on  the  surface,  or 
enter  through  wounds. 

The  poisons  occurring  in  solid  form  are  even  more 
numerous  than  the  others,  and  they  enter  the  body  in 
the  greatest  diversity  of  ways,  and  produce  manifold 
symptoms.  General  poisofis  include  a  great  variety  of 
substances,  such  as  arsenic,  phosphorus,  antimony,  mer- 
cury, lead,  and  a  great  many  more.  They  may  be  taken 


160  THE  CAUSES   OF   DISEASE 

knowingly  with  good  or  evil  intent,  or  in  ways  not 
known  at  the  time,  and  often  difficult  to  trace.  The 
amount  taken  at  one  time  may  be  almost  infinitely 
small,  yet  its  frequent  repetition  may  result  in  poison- 
ing. Thus,  a  painter  may  contract  lead-poisoning  from 
the  minute  amounts  of  lead  getting  on  his  food  from 
unwashed  hands,  a  beer-drinker  from  the  lead  taken 
into  solution  from  lead  pipes  through  which  the  beer  is 
drawn. 

Alkalies,  such  as  caustic  potash.,  caustic  soda,  lye, 
and  quicklime  are  powerful  irritants  or  caustics. 

Vegetable  poisons  include  substances  producing  dis- 
ease or  death  in  a  great  variety  of  ways.  Some  of  the 
most  common  and  familiar  of  these  are  opium,  strych- 
nine, cocaine,  ?iwA  jimp  son  weed.  Most  of  the  enslaving 
drugs  —  alcohol,  opium,  cocaine,  and  others  —  are  of 
vegetable  origin.  Habitual  users  of  them  may  get  to 
using  enormous  doses,  some  of  them  several  times  the 
amount  that  would  be  fatal  to  persons  not  so  habitu- 
ated. Some  vegetable  poisons  are  very  irritating  to  the 
skin  and  cause  marked  eruptions.  Croton  oil  causes 
pustules  that  resemble  those  of  smallpox.  Poison  ivy 
owes  its  evil  qualities  to  an  oil  that  occurs  in  and  on  the 
leaves  and  that  causes  the  well-known  inflammation  of 
the  skin. 

Many  of  the  chemical  poisons  are  the  products  of 
germ  action.  Alcohol,  the  best  known,  results  from  the 
action  of  yeast  cells  on  sugar.  Ptomaines  result  from 
the  action  of  germs  on  meats,  fish,  milk,  and  other  food- 
stuffs. There  are  a  great  many  of  them,  and  their  effects 
vary  greatly.  Some  of  them  resemble  drugs,  such  as 
morphine,  strychnine,  or  atropine,  in  their  action,  and, 
as  their  presence  may  not  be  suspected  at  the  time  they 


EXCITING  CAUSES  OF  DISEASE         161 

are  taken  into  the  system,  the  symptoms  produced  by 
them  may  prove  very  puzzling.  It  should  be  borne  in 
mind  that  ptomaines  may  not  be  destroyed  by  boiling, 
and  cooking  should  therefore  not  be  depended  upon  to 
render  partially  decomposed  meat  safe.  Many  of  them 
are  harmless,  but  neither  can  that  fact  be  depended 
upon  to  show  that  a  given  article  of  food  is  wholesome. 
Their  poisonous  character  depends  on  the  type  of  organ- 
ism producing  them,  rather  than  on  the  stage  of  decom- 
position. Thus  one  piece  of  meat  may  be  quite  rotten, 
and  yet  not  poisonous,  while  another  that  is  free  from 
odor  and  presents  a  fairly  good  appearance  may  be  very 
dangerous. 

The  foods  that  most  often  give  rise  to  jJtomaine  poi- 
soning are  those  that  have  been  preserved  imperfectly, 
such  as  beef  or  fish  in  cans  that  have  become  perfo- 
rated or  blown,  cold-storage  beef  that  is  not  well  frozen 
or  chilled,  poultry  imperfectly  chilled,  especially  if  it  be 
undrawn,  and  imperfectly  cured  hams  and  sausages. 
The  symptoms  vary  considerably,  depending  on  the 
source,  character,  and  amount  of  the  poison  ingested, 
but  in  most  instances  they  include  evidence  of  marked 
gastro-intestinal  and  nervous  disturbances,  such  as  vom- 
iting, diarrhoea,  headache,  dizziness,  and  cramps.  Self- 
jjoisoning  or  auto-intoxication  may  be  due  to  ptomaines 
or  other  decomposition  products  resulting  from  the 
putrefaction  of  food,  occurring  in  the  stomach  or  bowels, 
or  to  simple  retention  and  absorption  of  poisonous  pro- 
ducts which  would  ordinarily  be  eliminated,  but  which, 
because  of  constipation,  kidney  disease,  or  for  some 
similar  reason,  remain  in  the  body.  Such  poisonings  are 
promoted  by  overeating,  lack  of  exercise,  and  by  ex- 
cessive drinking  or  smoking,  as  well  as  by  diseases. 


162  THE   CAUSES   OF   DISEASE 

Animal  poisons,  in  addition  to  the  products  of  animal 
waste  to  which  reference  has  just  been  made,  include 
such  substances  as  snake-venoms  and  those  of  stinging 
insects  and  spiders.  These  vary  greatly  in  their  com- 
position, and  their  effects  range  from  the  slight  itching 
and  burning  of  a  mosquito  bite  to  the  agonizing  deaths 
following  some  snake  bites.  The  venoms  are  introduced 
through  wounds,  many  of  them  being  harmless  if  applied 
to  the  unbroken  skin  or  even  if  taken  by  mouth. 

The  most  important  group  of  the  larger  animal  par- 
asites that  infest  man  is  that  of  the  intestinal  worms. 
Their  distribution  is  world-wide,  and  in 
.°  some  places  they  are  so  prevalent  and  their 

^          .  effects  so  serious,  that  they  exercise  very 

iP3.r3sit6s    •  •  .  . 

important  influences  on  the  morbidity  and 

mortality  rates.  They  may  be  grouped  in  three  classes : 
the  flukes  or  sucking-worms,  the  tapeworms,  and  the 
roimdworms. 

Flukes  or  sucking -worms  are  not  common  parasites 
of  man  in  our  own  country,  but  in  some  parts  of  the 
world  they  are  very  prevalent  and  cause  serious  illness. 
Several  varieties  occur  in  the  Philippine  Islands,  and 
some  of  them  cause  death.  One  variety  occurs  in  the 
lungs,  and  causes  blood-spitting  and  cough  that  may 
lead  to  the  belief  that  tuberculosis  is  present ;  or  it  may 
lodge  in  the  brain  and  cause  paralysis  or  other  cerebral 
symptoms.  Other  varieties  live  in  the  veins  of  the  liver 
and  may  produce  disease  of  that  organ,  while  their  sharp- 
pointed  eggs  lodge  in  or  perforate  blood-vessels  of  the 
bowels  or  bladder  and  cause  bleeding,  irritation,  and 
other  symptoms.  This  a  is  type  of  the  schlstosomum 
disease  mentioned  in  the  preceding  chapter.  Although  it 
is  claimed  that  this  particular  class  of  flukes  may  enter 


EXCITING   CAUSES  OF   DISEASE  163 

the  body  through  the  skin,  this  is  not  yet  a  generally 
acknowledged  fact ;  and  the  usual  history  of  the  flukes 
is  that  they  pass  a  part  of  their  lives  in  the  bodies  of 
snails  or  other  small  water-animals/  and  enter  the  hu- 
man body  only  by  way  of  the  mouth.  Even  though  both 
methods  of  infection  be  possible,  the  obvious  means  of 
])revention  ai'e,  first,  to  prevent  infected  or  egg-bearing 
feces  or  urine  from  reaching  water;  second,  to  boil  or 
otherwise  sterilize  the  drinking  water  ;  third,  to  abstain 
from  bathing  in  infected  water  unless  it  also  be  boiled 
or  filtered ;  fourth,  to  avoid  the  use  of  uncooked  foods 
that  may  have  been  contaminated  by  bad  water. 

The  tapeworms  are  better  and  more  widely  known 
as  human  parasites.  There  are  many  varieties  of  them, 
but  the  best  known  are  those  large  species  ingested 
with  beef  and  pork,  though  others  are  important,  and 
some  of  these,  such  as  the  broad  tapeworm  from  fish, 
may  be  very  important  in  places.  The  life  history  of 
tapeworms,  while  not  so  complicated  as  that  of  flukes, 
involves,  in  most  instances,  residence  in  two  animals, 
and  knowledge  of  it  enables  us  to  understand  the  man- 
ner in  which  infestation  occurs,  and  the  method  of 
avoiding  it.  Life  begins  in  the  eggs,  which  are  passed 
from  the  worm  into  the  bowel-contents  of  its  host,  and 
thence  to  the  outer  world.  Here  they  may  fall  into  water 
or  on  vegetation,  or  the  excrement  itself  may  be  ingested 
by  animals.  At  any  rate,  the  eggs  must,  in  one  way  or 
another,  get  admission  to  the  alimentary  canal  of  the 
second  host,  for  which  purpose  a  particular  species  of 
animal  is  necessary.   In  the  case  of  the  beef  tapeworm, 

'  Flukes  in  general,  so  far  as  their  life-history  is  understoorl,  have  at 
different  times  four  forms  or  stages  and  two  or  three  methods  of  mul- 
tiplication. 


164  THE  CAUSES   OF   DISEASE 

this  host  is  the  ox,  in  that  of  the  pork  tapeworm,  the 
pig.  Rarely  this  development  may  occur  in  other  ani- 
mals, or  in  man  himself,  but  ordinarily  development  will 
not  occur  in  any  but  the  usual  host.  Having  reached 
the  stomach  of  this  host,  the  embryo  is  set  free  when 
its  enveloping  shell  is  dissolved,  and  penetrates  the  wall 
of  the  stomach,  whence  it  passes  by  the  blood  vessels  to 
the  liver,  muscles,  brain,  or  other  part  of  the  body, 
where,  after  undergoing  some  further  development,  it 
becomes  the  head  and  neck  of  a  future  worm,  inclosed 
in  a  small  bladder,  like  cyst  or  measle,  from  one  fourth 
to  three  fourths  of  an  inch  in  length  and  about  one  third 
of  an  inch  in  diameter  in  the  case  of  the  pork  measle, 
and  somewhat  smaller  in  the  case  of  the  beef  measle.  If 
now  the  flesh  of  the  infected  pig  or  ox  be  eaten  raw,  or 
not  cooked  sufficiently  to  kill  the  worm,  it  may  pass  un- 
harmed to  the  bowel  of  man  and  there  attach  itself  and 
grow.  The  head  and  neck  as  ingested  are  very  small, 
bearing  comparison  in  size  to  a  small  pinhead  and  a 
piece  of  fine  twine.  From  this  head  and  neck  the  rest  of 
the  worm  develops  in  the  bowel.  The  part  so  developing 
consists  of  a  great  number  of  segments,  at  times  hun- 
dreds, each  flat  and  white,  so  joined  together  as  to  form 
a  long  flat  ribbon  that  may  attain  a  length  of  thirty  or 
more  feet,  each  segment  having  a  nervous  and  alimen- 
tary system  and  male  and  female  generative  organs,  and 
each  developing,  fertilizing,  and  discharging  eggs,  so 
that  each  tapeworm,  though  an  individual,  may  be  said 
to  be  also  a  community.  It  may  be  readily  understood 
from  the  above  that  allowing  pigs  to  act  as  scavengers  of 
human  ordure,  as  is  often  the  case  in  the  tropics,  is  not 
a  wise  sanitary  measure.  It  was  stated  above  that  man 
might  rarely  be  the  measly  host.  In  such  cases  he  might 


EXCITING  CAUSES   OF   DISEASE  165 

become  infected  with  eggs  by  means  of  contaminated 
water,  or  of  lettuce  or  other  green  vegetables  manured 
with  human  feces,  by  getting  the  minute  eggs  on  his 
hands  in  water-closets  or  from  his  own  stool,  or  by 
having  them  pass  from  the  bowel  to  the  stomach  during 
vomiting.  Several  other  varieties  of  tapeworms  may 
infect  man,  —  one  of  the  most  dangerous,  and  one  for 
which  man  may  shelter  the  cystic  stage  with  fatal  re- 
sults, being  derived  from  the  dog,  and  another  danger- 
ous one  possibly  being  derived  from  the  rat,  which  may 
deposit  the  eggs  on  food  articles  with  its  feces. 

Many  varieties  of  rornidworms  infest  man,  and  their 
life-histories  vary  greatly,  A  few  varieties  will  be  briefly 
discussed  in  order  to  indicate  more  clearly  the  neces- 
sity of  certain  sanitary  precautions.  Those  most  com- 
monly inhabiting  the  human  intestine  —  thelarge^whUe 
roundworm,  the  whipworm,  and  the  pimvorm  or  seat- 
worm —  require  no  other  host,  and  infection  occurs, 
directly  or  indirectly,  from  man  to  man.  The  eggs  are 
laid  in  the  feces  and  pass  from  the  anus,  whence  they 
may  get  on  the  hands,  into  drinking  water,  or  on  green 
vegetables,  and  so  obtain  entrance  to  the  mouth  and 
stomach  of  the  same  or  another  person.  The  embryos 
are  set  free  in  the  stomach  or  intestine  and  develop 
into  adults.  Probably  the  most  common  method  of  in- 
fection is  by  means  of  polluted  water.  Children  and 
adults  who  are  infested  with  seat-worms  may  reinfect 
themselves  many  times,  by  reason  of  the  fact  that  these 
worms  often  crawl  from  the  anus  and  give  rise  to  most 
intense  itching,  in  the  efforts  to  relieve  which  the 
hands  and  nails  ])ick  up  many  of  the  microscopic  eggs, 
which  may  later  be  transferred  to  the  nose  or  mouth. 

The  hookworms  are  probably  the  most  important  of 


166  THE  CAUSES   OF  DISEASE 

all  the  worms  infesting  man,  both  because  they  may 
and  do  infect  the  great  majority  of  the  inhabitants  in 
some  tropical  countries,  and  because  they  so  seriously 
reduce  health  and  strength.  In  Porto  Rico,  the  Philip- 
pines, and  our  own  Southern  States,  infestation  with 
these  worms  is  common,  and  thousands  and  thousands 
of  persons  are  debilitated  or  incapacitated,  and  have 
their  resistance  to  other  disease  reduced  by  it,  with 
the  result  that  industrial  progress  is  delayed  and  physi- 
cal degeneracy  and  high  sickness  and  death-rates  pro- 
moted. Formerly  it  was  believed  that  infestation  with 
this  parasite  occurred  in  the  same  manner  as  with  those 
just  described,  but  it  is  now  generally  admitted  that  it 
usually,  if  not  always,  occurs  in  another  way.  The  usual 
history  is  about  as  follows :  The  adult  female  pro- 
duces a  great  number  of  eggs  that  pass  out  from  the 
host  with  his  feces.  If  passed  on  moist,  warm  earth, 
the  eggs  hatch  and  liberate  microscopic  embryonic 
worms  which  eat  feces  or  other  organic  matter,  live 
and  grow  in  the  moist  earth,  and  eventually,  if  fortu- 
nate, find  an  opportunity  to  get  on  the  bare  feet  or 
other  skin -surface  of  a  person,  and  at  once  penetrate 
the  hair  follicles  and  the  true  skin,  producing  itching 
and  irritation,  gain  access  to  the  lymph  or  blood-ves- 
sels of  their  host,  and  are  carried,  by  way  of  these 
channels,  to  the  lungs.  Here  they  leave  the  blood  and 
pass  out  on  the  mucous  membrane,  crawl  up  the  wind- 
pipe to  the  throat,  from  there  down  to  the  stomach, 
and  then  to  the  small  intestine,  where  they  take  up 
their  abode,  reach  adult  life  and  a  length  of  one  third 
or  one  half  an  inch,  and  in  turn  produce  eggs  to  infect 
more  polluted  soil.  In  addition  to  this,  they  produce  a 
very  serious  ansemia  or  thinning  of  the  blood,  which 


EXCITING   CAUSES   OF   DISEASE  167 

gives  rise  to  weakness,  shortness  of  breath,  dropsy, 
mental  dullness,  and,  in  children,  checked  develop- 
ment and  stunted  physique  and  mentality.  Such  con- 
ditions impair  the  body's  resisting  powers,  and  the  vic- 
tims more  readily  succumb  to  malaria,  dysentery,  and 
other  diseases. 

The  short  outline  of  the  life-history  of  the  worm  just 
given  indicates  the  wisdom  of  the  following  measures 
to  prevent  the  spread  of  the  infestation:  first,  treat- 
ment of  all  infested;  second,  proper  disposal  of  feces 
to  prevent  soil-pollution  ;  third,  the  wearing  of  shoes 
in  infected  regions ;  fourth,  the  use  of  pure  drinking 
water. 

Trichiniasis  is  a  disease  produced  by  infestation 
with  a  kind  of  roundworms,  trlchince,  that  presents 
still  another  life-history  and  method  of  infestation. 
The  trichinae  are  small  worms  about  a  sixteenth  of  an 
inch  in  length  that  are  natural  parasites  of  the  rat,  but 
may  also  infest  man  and  many  other  animals,  including 
the  pig  and  dog.  The  danger  to  man  lies  principally  in 
the  fact  that  the  pig  is  a  rather  common  host,  and  it  is 
from  that  source  that  he  derives  his  infection.  The 
history  is  as  follows  :  Rats  become  infested  by  eating 
their  infested  kindred,  and  they  in  turn  may  be  eaten 
by  pigs.  The  larval  worms  are  encysted  in  the  muscles, 
as  will  be  described  later,  and  are  set  free  in  the  pig's 
stomach,  when  the  muscle  and  cyst  are  digested.  They 
then  pass  to  the  bowel,  where  they  take  up  their  abode, 
mature,  and  bore  into  or  through  the  intestinal  wall 
to  the  lymph  spaces,  where  they  deposit  their  numer- 
ous progeny,  averaging  about  fifteen  hundred  in  num- 
ber. These  are  carried  along  by  lymph  or  blood-streams, 
or  possibly  by  their  own  activity,  to  vai'ious  parts  of 


168  THE  CAUSES  OF   DISEASE 

the  body,  finally  penetrating  the  muscle  fibres  and  set- 
ting up  an  irritation  that  results  in  the  formation  of 
little  capsules  about  them.  Here  they  live  quiescent, 
but  capable  of  development,  for  an  indefinite  time, 
occasionally  for  years.  Too  often,  however,  this  rest 
is  shortened  by  the  death  of  the  pig  and  its  later  con- 
sumption by  man.  If  such  consumption  is  preceded 
by  thorough  cooking  no  harm  will  result,  as  the  heat 
will  destroy  the  worms  ;  but  if,  as  is  sometimes  the 
case,  the  meat  be  eaten  raw  or  underdone,  the  larvae 
are  set  free  in  the  man's  stomach  as  the  others  were  in 
the  pig's,  and  he  in  turn  develops  adults,  has  larvae 
scattered  through  his  muscular  system,  and  suffers  from 
pain,  fever,  symptoms  resembling  typhoid,  and,  possibly, 
death. 

Filaria^  a  roundworm  whose  larvae  circulate  in  the 
blood,  presents  a  still  different  history  and  method  of 
entrance  to  the  body.  For  at  least  two  varieties,  whose 
development  has  been  pretty  well  traced,  the  history  is 
as  follows  :  The  young  or  embryonic  forms  are  imbibed 
with  blood  by  mosquitoes  that  bite  infected  persons.  In 
the  blood  these  embryos,  which  are  about  one  eightieth 
of  an  inch  in  length,  are  inclosed  in  loose  individual 
sheaths  or  capsules,  within  which  they  wriggle  about 
very  actively.  After  reaching  the  mosquito's  stomach 
the  blood  containing  them  clots  and  they  break  through 
their  sheaths,  and,  after  about  a  day,  through  the 
stomach-wall.  They  live  in  the  body  of  the  mosquito, 
growing  and  maturing,  for  two  weeks  or  more,  at  the 
end  of  which  time  they  have  increased  to  four  or  more 
times  their  original  length,  and  have  gathered  in  or 
about  the  fleshy  part  of  the  mosquito's  proboscis.  When 
the  mosquito  next  bites  a  man  they  break  through  a 


EXCITING  CAUSES  OF   DISEASE  169 

thin  part  of  the  proboscis  and  pass  through  his  skin  by 
the  small  wound  from  which  the  mosquito  is  extracting 
blood.  Once  in  the  body,  they  wander  in  ways  and 
parts  unknown  for  an  indefinite  time,  until  they  reach 
maturity,  and,  if  both  sexes  be  represented,  begin  to 
turn  out  embryos  for  other  mosquitoes  to  ingest.  The 
adults  are  very  apt  to  take  up  their  abode  in  lymph- 
vessels,  and  by  their  residence  there  they  set  up  irrita- 
tion that  leads  to  blocking  or  obliteration  of  the  chan- 
nels and  is  thought  to  be  the  cause  of  lymph-scrotum, 
chyluria  (milky  urine),  elephantiasis,  and  kindred 
troubles.  Certain  insect  larvce  that  bear  a  resemblance 
to  roundworms  occasionally  infest  man.  Blow-flies  may 
deposit  their  eggs  on  meat  that  is  left  carelessly  ex- 
posed, and,  if  they  are  not  destroyed  by  heat,  maggots 
may  hatch  from  them  and  appear  in  the  stools  of  per- 
sons eating  it.  Flies  also  deposit  eggs,  and  maggots  de- 
velop, on  neglected  sores,  wounds,  or  ulcers,  which  may 
later  be  burrowed  in  many  directions. 

Screw-wo7'ms  are  the  maggots  of  a  small  fly  found 
in  some  of  our  Southwestern  States  and  elsewhere. 
This  fly  deposits  its  eggs  in  the  nostrils,  or,  occasionally, 
on  other  parts  of  sleeping  persons,  especially  those 
afflicted  with  nasal  disease  or  very  foul  breath.  The 
maggots  hatch  out  in  a  few  hours  and  crawl  and  bore 
their  way  in  all  directions,  causing  great  suffering  and, 
in  many  cases,  death.  Among  twenty-three  cases  re- 
ported from  Arizona  in  the  fly  season  of  1905,  there 
were  four  deaths. 

Some  flies  deposit  their  eggs  on  or  in  the  skin  of 
animals,  and  the  larvae  develop  there,  constituting 
"warbles"  in  cattle,  deer,  and  wild  rabbits.  Occasion- 
ally man  is  host,  though  this  is  rarely  so. 


170  THE  CAUSES   OF  DISEASE 

Some  insects  burrow  into  or  beneath  the  skin  in  their 
adult  condition,  and  there  nourish  themselves  and  some- 
times deposit  their  eggs  or  their  young.  They  cause 
irritation  or  disease.  Among  them  may  be  mentioned 
the  itch-mite,  jiggers  or  chiggers,  and  many  kinds  of 
ticks.  Itch  was  at  one  time  a  very  widespread,  com- 
mon, and  intractable  disease,  but  is  no  longer  so. 

Lice  of  various  kinds  are  also  less  common  than 
formerly,  but  are  still  seen  often  enough  as  human 
parasites. 

Leeches  are  at  times  a  great  pest  and  cause  much 
loss  of  blood,  particularly  in  some  parts  of  the  Philip- 
pines, where  they  get  on  troops  marching  through  the 
jungle,  in  great  numbers.  They  may  get  on  the  body 
from  water  or  from  vegetation.  Clothing  is  the  main 
source  of  protection  from  them. 

A  number  of  very  important  and  well-known  diseases 
are  caused  by  animal  parasites  of  such  extremely  small 
size  and  so  low  in  the  scale  of  animal  life 
.  that  they  may,   for  our  purposes,  be  re- 

.  garded  as  closely  allied  to  the  bacteria.    In 

fact,  even  scientists  are  not  agreed  as  to 
whether  some  of  them,  for  instance  the  germs  of 
syphilis,  yaws,  and  relapsing  fever,  are  animal  or  vege- 
table. A  brief  consideration  of  some  of  the  small  ani- 
mal parasites  and  the  diseases  they  cause  may  be 
helpful. 

Malaria  is  the  best  known  and  most  common  of 
such  diseases,  and  the  parasites  causing  it  are  better 
known  than  most  of  the  others  occurring  in  man. 
There  are  at  least  three  varieties  of  malaria,  each  caused 
by  its  peculiar  type  of  organism,  though  these  types 
have  much  in  common.  They  all  live  in  the  blood  and 


EXCITING   CAUSES   OF   DISEASE  171 

in  its  red  corpuscles,  when  so  small  as  to  be  almost  in- 
visible with  the  microscope,  and  there  grow  to  a  consid- 
erable size,  destroying  the  blood-cell  and  converting  it 
into  a  mere  shell  and  some  pigment  granules.  In  twenty- 
four,  forty-eight,  or  seventy-two  hours,  depending  on 
the  variety  of  organism,  they  segment  or  break  up  into 
a  number  of  small  new  organisms,  the  number  varying 
from  six  or  eight  to  fifteen  or  twenty,  and  also  depend- 
ing on  the  type.  These  young  forms  are  set  free  in  the 
blood-stream  with  the  breaking  up  of  the  shell  of  the 
blood-corpuscle  in  which  they  were  contained,  and  in 
turn  attach  themselves  to  new  red  cells,  to  repeat  the 
performance.  Corresponding  to  the  liberation  of  the 
swarms  of  young  comes  the  "  ague  fit,"  or  the  malarial 
chill,  fever,  and  sweat,  and  it  depends  upon  the  type  of 
organism  whether  this  comes  da.ily,  once  in  two  days,  or 
once  in  three.  Various  combinations  of  infections  may 
make  the  chills  appear  to  come  very  irregularly,  but 
such  irregularities  are  often  explainable  if  the  case  be 
well  studied.  After  a  time  the  body  develops  powers  of 
resistance  that  enable  it  to  overcome  the  effects  of  the 
organism,  and  spontaneous  recovery  may  occur.  Or  the 
recovery  may  be  apparent  only,  and  the  disease  may 
recur  when  chill,  exposure,  or  other  illness  lowers  vi- 
tality. Malaria  causes  many  deaths,  especially  in  the 
tropics  ;  but  if  a  single  infection  is  not  fatal  very  soon, 
the  tendency  is  to  recovery,  as  the  parasites  cannot 
maintain  their  powers  indefinitely  unless  they  renew 
their  strength  (in  some  unknown  way)  by  sexual  re- 
p7'oduction,  and  that  can  only  occur  in  mosquitoes  of 
certain  kinds.  Minute  differences  can  be  detected  among 
the  parasites  of  any  kind  of  infection,  and  these  are 
now  known  to  mark  sexual  differentiation.  If  the  right 


172  THE  CAUSES  OF   DISEASE 

kind  of  mosquito  bites  the  infected  individual,  these 
sexual  differences  become  more  marked  in  its  stomach, 
and  sexual  conjugation  there  takes  place.  The  impreg- 
nated female  (this  term  is  not  accurate  but  it  conveys 
the  idea)  bores  into  the  stomach-wall  and  undergoes  a 
development  which  eventually  results  in  the  production 
of  hundreds  or  thousands  of  young  forms  that  finally 
find  their  way  to  the  salivary  glands  and  mouth  of  the 
mosquito,  and  enter,  by  way  of  the  wound  made  by  the 
insect,  the  next  man  it  bites,  and  the  cycle  begins 
again  in  him.  All  malarial  infections  are  conveyed  in 
this  way,  and  where  there  are  not  the  right  kinds  of  mos- 
quitoes the  disease  cannot  originate.  So  far  as  known, 
man  is  the  only  animal,  and  mosquitoes  of  the  sub- 
family anophalinm  the  only  insects,  that  respectively 
harbor  and  transmit  malaria,  and  each  derives  its  in- 
fection from  the  other.  Each  should  therefore  be  kept 
away  from  the  other. 

Amoebic  dysentery,  so  well  known  to  our  army  because 
of  the  great  amount  of  invalidism  it  has  produced 
among  our  soldiers  on  tropical  service,  is  also  due  to 
an  animal  parasite  of  microscopic  size.  This  is  a  minute 
round  mass  of  living  substance  endowed  with  the  ca- 
pacity for  motion,  by  virtue  of  which  it  inserts  itself 
between  the  body-cells  or  wraps  itself  about  them  and 
digests  them ;  destroying  tissue  and  giving  off  poison, 
it  causes  the  formation  of  ulcers  in  the  bowel,  inflam- 
mation of  the  intestinal  surface,  bleeding,  wasting,  diar- 
rhcea,  and,  too  often,  death.  Entering  the  blood  or 
lymph-streams  through  the  ulcers  they  make  in  the 
bowel,  the  amoehas  may  reach  the  liver  and  there  set  up 
the  dreaded  disease  known  as  liver  abscess.  Theamcebas 
enter  the  body  in  polluted  water,  and  probably  also  on 


EXCITING  CAUSES  OF  DISEASE         173 

lettuce,  radishes,  and  other  vegetables  that  are  eaten 
uncooked. 

Sleeping  sickness,  a  disease  unknown  in  our  posses- 
sions but  caused  by  a  parasite  closely  related  to  that 
causing  the  well-known  and  fatal  surra  of  horses  in 
the  Philippines,  is  widespread  in  central  Africa,  and 
threatens  to  depopulate  immense  tracts  there.  The 
organism  and  the  disease  ai'e  transmitted  by  a  biting  fly. 

Syphilis,  known  everywhere,  is  caused  by  an  ex- 
tremely fine  oi'ganism  of  spiral  figure.  This  is  about 
1-2000  of  an  inch  in  length,  and  the  thread  that  is 
twisted  into  the  spiral  shape,  the  organism  itself,  is 
about  1-100,000  of  an  inch  thick.  This  extreme  fine- 
ness, and  the  difficulty  with  which  the  germ  stains, 
account  for  the  fact  that  it  was  only  recently  discov- 
ered. This  organism,  which  is  called  a  Treponema,  is 
not  known  to.  occur  elsewhere  than  in  syphilitic  sub- 
jects, but  it  occurs  abundantly  in  lesions  of  the  disease 
and  is  free  on  the  surface  of  such  moist  sores  as  the 
open  chancre  and  patches  in  the  mouth.  If  from  these 
it  passes  to  wounds,  cracks,  or  other  open  and  moist 
surfaces  on  a  healthy  person,  as  may  occur  in  kissing, 
sexual  congress,  or  other  contact,  the  disease  is  trans- 
mitted. 

Yaws,  a  skin  disease  that  occurs  in  the  tropics,  is 
caused  by  an  organism  indistinguishable  from  that  of 
syphilis. 

Many  other  diseases  are  produced  by  animal  para- 
sites, but  it  is  unnecessary  to  consider  them  here. 

Certain  diseases,  such  as  yelloio  fever  and  dengue^ 
are  produced  by  unknown  organisms  that  pass  through 
fine  filters  and  are  probably  so  small  as  to  be  invisible 
to  our  microscopes  ;  yet  the  course  and  history  of  the 


174  THE   CAUSES  OF   DISEASE 

diseases  point  to  an  animal   rather  than  a  vegetable 
cause. 

The   disease-producing   vegetable    parasites   are  of 

three  classes,  moulds,  yeasts,  and  bacteria,  all  microscopic 

in  size  and  all  of  them  germs.  The  moulds 

°  and  yeasts    are    of  minor  consequence  as 

Pay  a  sites  •  . 

compared  with  the  bacteria,  and  cause  rela- 
tively few  diseases,  and  those  principally  of  the  skin. 
Fatal  general  infections  by  germs  from  both  of  these 
classes  have,  however,  been  reported.  Persons  who  have 
served  in  the  tropics  recall  how  difficult  it  is  there  to 
keep  shoes,  clothing,  trunks,  and  many  other  articles 
from  moulding  or  mildewing,  especially  during  the 
rainy  season.  Heat  and  moisture  afford  such  excellent 
conditions  for  growth  that  a  pair  of  shoes  will  turn 
green  in  a  very  short  time.  As  related  vegetable  forms 
are  responsible  for  many  of  the  most  common  skin- 
diseases  of  the  tropics,  the  fact  helps  us  to  understand 
the  prevalence  of  the  latter.  Not  all  moulds  are  harm- 
ful, and  most  of  them  are  mere  surface  growths.  The 
mistake  is  occasionally  made  of  rejecting  a  quite  good 
ham,  for  instance,  because  it  is  mouldy  on  the  outside. 
Such  mould  can  be  trimmed  off  with  the  rind,  and  does 
not  injure  the  meat.  Roquefort  and  some  other  cheeses 
are  dependent  on  moulds  for  their  flavor,  and  are  not 
good  if  these  be  absent. 

Bacteria,  however,  are  the  best  known  of  the  causes 
of  disease,  so  well  known  as  such,  in  fact,  that  two 
.  erroneous  ideas  have  arisen  in  consequence: 
one,  that  all  bacteria  produce  disease,  the 
other  that  all  disease-producing  germs  or  micro-organ- 
isms are  bacteria,  or,  to  touch  a  still  greater  error, 
bacilli.  Bacteria  are  microscopic,  one-celled  organisms 


EXCITING  CAUSES   OF   DISEASE         175 

of  vegetable  nature  that  multiply  by  simple  fission.  So 
far  are  they  from  being  universally  harmful,  that  life 
would  soon  disappear  from  the  face  of  the  earth  if  all 
bacteria  were  killed.  This  is  because  of  the  fundamen- 
tal difference  that  exists  between  bacteria  and  the 
larger  forms  of  vegetation.  All  animal  life  is  main- 
tained directly  or  indirectly  by  vegetable  life,  even  the 
lion  and  tiger  being  dependent  on  the  herbivorous  deer 
and  similar  animals.  Most  vegetable  life  draws  its  sub- 
stance from  the  elements  and  simple  compounds  of  the 
earth,  air,  and  water.  In  other  words,  grass  or  a  tree 
cannot  eat  dead  grass,  meat,  or  other  highly  organized 
substances,  until  they  are  first  decomposed  and  broken 
up  into  the  elements  and  simple  compounds  indicated, 
and  returned  i-n  those  forms  to  the  earth,  air,  or  wjiter. 
For  this  purpose  bacteria  are  necessary,  and  without 
their  action  the  earth  would  soon  be  covered  with  dead 
animals  and  vegetables,  the  fertility  of  the  soil  would 
be  exhausted,  and  life  would  be  choked  out  by  the 
accumulation  of  its  products.  Familiar  and  concrete 
examples  of  their  value  are  furnished  by  agriculture, 
soil  that  will  not  produce  peas,  for  instance,  being 
made  to  raise  them  of  excellent  quality  by  the  mere  ad- 
dition of  certain  bacteria.  Their  importance  being  so 
great,  it  is  evident  that  their  distribution  is  practically 
universal.  Many  trades  are  partly  or  entirely  depend- 
ent on  bacteria,  yeasts,  and  moulds.  Among  them  may 
be  mentioned  brewing,  and  wine,  vinegar,  cheese,  and 
butter-making. 

Bacteria  are  variously  classified  according  to  shape, 
action,  and  other  qualities.  Thus  some  are  called  putre- 
factive, others  nutrifying  or  denutrifying,  and  others 
pathogenic  or  disease-pi'oducing.     The  more  commou 


176  THE   CAUSES   OF   DISEASE 

forms  are  designated  as  cocci,  or  little  balls,  bacilli,  or 
little  rods,  and  spiriUi  or  vibrios,  or  little  spirals  or 
pieces  of  spirals.  Cocci  in  pairs  are  called  cJiplococci ; 
bound  together  in  chains,  streptococci ;  gathered  into 
bunches  like  grapes,  staphylococci ;  and,  as  each  organ- 
ism tends  to  grow  always  in  the  same  way,  such  names 
become  permanently  attached  as  more  or  less  specific. 
Thus  we  speak  of  the  streptococcus  of  erysipelas,  the 
diplococcus  of  pneumonia,  and  the  yellow  staphylo- 
coccus of  suppuration. 

Bacteria  may  also  be  cerobic'  or  ancerobic;  the  for- 
mer unable  to  live  without  oxygen,  the  latter  with  it. 
Tetanus  or  lockjaw  is  caused  by  an  anaerobic  bacillus, 
and  that  probably  partly  accounts  for  the  fact  that  it  is 
most  apt  to  follow  small  deep  wounds,  such  as  nail- 
punctures,  to  which  the  air  does  not  have  free  access. 

Reproduction  among  bacteria  is  by  fission  or  simple 
division.  One  bacillus  divides  crosswise  into  two,  the 
two  into  four,  and  so  on  ;  and  so  rapidly  does  the  pro- 
cess advance,  that  under  favorable  circumstances  the 
increase  amounts  to  uncountable  millions  or  billions  in 
a  day.  The  rapidly  multiplying  individuals  may  be 
bound  together  in  gelatinous  masses  that  are  of  con- 
siderable size,  at  times  forming  a  layer  of  skin  many 
yards  in  extent.  When  conditions  are  less  favorable,  as 
when  all  the  food-supply  is  exhausted,  the  temperature 
too  high,  or  harmful  chemical  substances  present,  the 
bacteria  usually  die  ;  but  some  varieties  may  preserve 
themselves  under  such  circumstances  by  the  formation 
of  spores.  These  may  be  compared  to  the  seeds  of 
larger  plants  in  that  they  are  much  more  resistant  to 
heat,  cold,  and  other  harmful  influences,  and,  after  sur- 
viving such  trials,  may  again  give  rise  to  growth.  An- 


EXCITING  CAUSES   OF   DISEASE         177 

thrax  bacilli,  for  instance,  are  readily  destroyed  by 
heat,  but  their  spores  will  withstand  boiling  for  some 
time.  In  preparing  media  for  the  cultivation  of  bacteria 
it  is  therefore  the  practice  to  sterilize  them  at  a  temper- 
ature higher  than  that  of  boiling  water,  or  to  use  that 
temperature  on  three  successive  days.  In  the  latter 
event  the  bacteria  develop  from  the  spores  after  the 
first  sterilization  and  are  killed  in  their  less  resistant 
forms.  The  amount  of  heat  required  to  destroy  bacteria, 
what  is  called  the  thermal  death-point,  varies  greatly 
with  the  species.  Some  organisms  found  in  water,  none 
of  which,  fortunately,  produce  disease,  flourish  in  a  high 
temperature.  All  disease-producing  organisms,  except 
those  in  spore  form,  are  promptly  destroyed  by  boiling, 
and  many  of  them  by  a  lower  temperature.  Few  ordi- 
nary organisms  will  survive  a  temperature  of  57°  C. 
for  more  than  a  short  time,  and  this  fact  gives  the  pro- 
cess of  pasteurization,  as  applied  to  milk,  its  value. 
This  is  the  process  whereb}'  milk  is  heated  to  a  point 
between  65°  and  70°  C.  and  maintained  at  that  tem- 
perature for  ten  or  fifteen  minutes.  This  kills  the  dis- 
ease-producing organisms,  without  changing  the  taste 
and  character  of  the  fluid  as  does  boiling.  For  the 
same  reason,  satisfactory  results  have  been  obtained  in 
the  British  service  with  a  camp  water-heater  that 
raises  the  supply  to  85°  C.  for  only  a  very  short  time. 

Moisture  is  necessary  for  the  growth  of  bacteria,  and 
drying  checks  their  growth  even  when  it  does  not  kill 
them,  as  it  does  many  varieties.  Being  solid  bodies 
heavier  than  air,  bacteria  are  not  given  off  from  moist 
surfaces.  Occasionally  they  may  be  thrown  into  the  air 
with  droplets  of  water  by  the  bursting  of  bubbles,  but 
in  general  a  tubf  ull  of  bacteria-laden  water  would  not 


178  THE   CAUSES   OF   DISEASE 

endanger  the  purity  of  the  atmosphere.  On  the  other 
hand,  dried  or  partially  dried  bacteria  may  be  blown 
about  as  dust  and  do  much  harm.  Cuspidors  and  water- 
closets  should  therefore  always  contain  water.  Sunlight 
is  a  great  enemy  to  most  pathogenic  bacteria,  some  of 
them,  for  example  the  cholera  germ,  being  killed  by  a 
very  brief  exposure  to  it,  and  all  being  injured  by  it. 
Many  chemicals,  such  as  bichloride  of  mercury  and 
carbolic  acid,  kill  bacteria  when  brought  into  contact 
with  them.  Such  mistakes  are  often  made  as  that  of 
regarding  a  stool  disinfected  because  some  antiseptic 
solution  has  been  poured  over  it.  As  a  matter  of  fact, 
the  antiseptic  in  such  a  case  is  only  brought  in  contact 
with  the  surface  of  the  fecal  mass  and  the  great  bulk 
of  it  is  quite  as  dangerous  as  before. 

One  variety  of  bacteria  may  tend  to  destroy  another. 
Thus  typhoid  bacilli  will  keep  alive  much  longer  in 
sterilized  than  in  contaminated  water,  the  common 
water-organisms  in  the  last  case  crowding  them  out ; 
and  fecal  matter  and  its  contained  bacteria  are  very 
quickly  made  to  disappear  if  mixed  with  dry  earth 
containing  an  abundance  of  nutrifying  bacteria,  while, 
if  mixed  with  ashes,  which  are  sterile  because  burned, 
they  persist  much  longer.  This  warfare  of  bacteria  has 
had  a  recent  exploitation  because  of  the  interest  attach- 
ing to  the  recommendation  that  certain  milk-souring 
bacteria  be  ingested  for  the  purpose  of  crowding  out 
from  the  intestines  more  harmful  varieties,  and  so  les- 
sening the  danger  of  poisoning  by  the  products  of  these. 
This  explains  the  occasional  excellent  effects  of  the  use 
of  buttermilk  as  a  diet. 

On  the  other  hand,  one  variety  of  bacteria  may  in- 
crease the  danger  or  power  of  another  variety.    Thus 


EXCITING    CAUSES  OF  DISEASE         179 

the  tetanus  bacillus,  being  anaerobic,  cannot  grow  in 
the  presence  of  oxygen ;  but  if  introduced  into  the  body 
with  a  variety  of  organism  that  uses  a  great  deal  of 
oxygen,  the  latter  may  soon  bring  about  practi(;ally 
anaerobic  conditions  in  which  the  former  can  flourish. 
The  virulence  of  the  streptococcus  of  erysipelas  is 
greatly  increased  if  the  organism  be  grown  with  bacillus 
prodif/iosus,  an  organism  that  is  itself  not  pathogenic. 
Smallpox,  though  more  than  a  single  suppuration,  is 
always  associated  with  that  process  and  with  the  com- 
mon pus-producing  bacteria.  Bacteria  in  general  pro- 
duce disease  by  means  of  the  poisons  or  toxins  that 
they  elaborate  or  set  free,  rather  than  by  their  phy- 
sical presence,  though  in  many  instances,  such  as  plague, 
cholera,  typhoid,  and  tuberculosis,  the  toxin  is  only  set 
free  when  the  organisms  die  and  disintegrate,  so  that 
their  actual  presence  in  the  body  is  necessary  for  the 
production  of  symptoms.  Other  bacteria,  notably  the 
germs  of  tetanus  and  diphtheria,  produce  soluble  toxins 
which  can  be  obtained  in  germ-free  solution,  and  which, 
when  injected,  produce  the  symptoms  of  disease,  even 
though  the  actual  germs  are  not  introduced.  In  nature, 
however,  disease  is  rarely  or  never  produced  in  that 
way,  the  germs  always  being  present,  though  it  may  be 
only  on  a  surface,  such  as  the  lining  of  the  mouth  or 
bowel,  the  toxin  being  the  only  part  actually  getting 
into  the  blood  or  tissues.  It  is  an  interesting  fact  that 
living  and  virulent  cholera  organisms  may  be  injected 
beneath  the  skin  by  the  billions,  with  no  other  result 
than  local  irritation  and  a  resulting  increased  resistance 
to  the  disease,  although  the  same  organisms  in  the 
bowel,  but  actually  outside  of  the  body-tissues,  might 
cause  death. 


CHAPTER  X 

DISEASE-CARRIERS 

It  has  been  stated  in  preceding  chapters  that  diseases 
are  oftentimes  diffused  by  persons,  animals,  insects,  or 
inanimate  substances  that  act  as  carriers  of  the  infect- 
ive matter  or  germs.  It  will  greatly  aid  in  the  main- 
tenance of  the  health  of  troops  if  company  officers  and 
the  men  themselves  have  a  proper  realization  of  such 
methods  of  spreading  disease,  and  the  better  known 
and  more  important  groups  of  carriers  will  therefore 
be  considered. 

Man  himself  is  the  most  important  carrier  of  his  own 

diseases,  and  most  epidemics  arise  from  the  presence  of 

one  case  of  disease  in  man.   Isolation  and 

^    .  quarantine  are  designed  to  limit  or  prevent 

^  disease-transmission  in  this  way,  and  in  the 

case  of  measles,  scarlet  fever,  smallpox,  and  similar 
diseases  the  danger  is  recognized  by  all.  It  is  not  so 
generally  recognized  in  many  other  common  and  serious 
diseases,  such  as  typhoid  and  "  colds."  It  is  not  the 
purpose,  however  to  discuss  here  the  danger  arising 
from  contact  with  well-marked  cases  of  disease,  but 
rather  to  consider  the  unknown  or  unrecognized  carrier. 
Several  diseases  may  be  widely  disseminated  by  persons 
entirely  ignorant  of  the  fact  that  they  are  sources  of 
danger.  This  fact  has  long  been  recognized  in  regard  to 
some  infections,  is  just  receiving  recognition  in  regard 
to  some  others,  and  is  possibly  not  recognized  at  all  in 
regard  to  still  others.   For  several  years  it  has  been  a 


DISEASE-CARRIERS  181 

matter  of  scientific  demonstration  that  active  and  viru- 
lent dii^litheria  bacilli  may  linger  for  weeks  or  months, 
in  the  mouths,  throats,  or  noses  of  persons  who  have  re- 
covered from  the  disease  and  who  appear  quite  healthy. 
It  has  also  been  demonstrated  beyond  dispute  that  some 
mild  sore  throats,  "  colds,"  and  nasal  discharges  are  due 
to  diphtheria  germs,  even  though  the  subjects  do  not 
feel  particularly  sick  and  the  diseased  parts  do  not  pre- 
sent the  appearance  formerly  considered  characteristic 
of  diphtheria.  Other  persons  who  have  no  sore  throat 
or  other  evidence  of  disease,  but  who  have  been  in  con- 
tact with  cases,  as  nurses  or  otherwise,  may  harbor  the 
germs.  Persons  in  any  of  these  classes  may  ignorantly 
and  innocently  introduce  the  disease  in  new  localities, 
transmit  the  germs  to  susceptible  people,  and  so  start 
epidemics.  One  such  person  in  a  crowded  and  ill-venti- 
lated squad-room  in  winter  may  endanger  the  whole 
command,  and  if,  in  addition  he  is  a  person  addicted 
to  careless  spitting,  to  the  use  of  other  men's  pipes, 
cups,  or  linen,  the  danger  is  greatly  increased.  The  wise 
and  necessary  precaution  in  military  life  is  to  examine 
and  reexamine  all  men  who  have  had  or  been  exposed 
to  diphtheria,  and  to  keep  them  isolated  until  it  has 
been  repeatedly  demonstrated  that  they  are  free,  from 
germs,  and  to  isolate  cases  of  sore  throat  as  though  they 
were  all  diphtheric. 

The  germs  of  pneumonia  and  of  cerebrospinal  men- 
ingitis are  also  occasionally  found  in  healthy  mouths 
and  noses,  and  it  is  quite  possible  tiiat  those  diseases 
may  occasionally  be  transmitted  in  a  similar  manner. 
Scarlet  fever  often  leaves  an  irritated  tliroat,  a  nasal 
discharge,  or  a  running  ear,  and  persons  who  have  other- 
wise recovered  from  it  may  transmit  the  infection  to 


182  THE  CAUSES  OF   DISEASE 

others  and  thus  start  epidemics.  It  is  only  recently  that 
a  somewhat  similar  origin  for  epidemics  of  tiji^hoid  has 
been  recognized ;  but  so  many  instances  are  now  recorded 
as  to  leave  no  doubt  of  the  possibility,  and  as  to  make 
it  seem  probable  that  the  disease  is  often  spread  in  that 
way.  Persons  who  have  recovered  from  the  disease 
months  or  years  before,  and  have  since  seemed  in  ex- 
cellent health,  have  been  shown  to  be  passing  almost 
pure  cultures  of  the  typhoid  bacilli  in  their  stools,  and 
to  have  caused  many  epidemics.  In  no  instance  did  they 
know  that  they  were  carrying  the  germs  or  were  sources 
of  infection.  These  carriers  will  be  discussed  again  in 
the  chapter  in  Part  III  dealing  with  typhoid  fever. 

The  germs  of  cholera  and  dysente')^  may  be  passed 
by  persons  quite  ignorant  of  the  fact  that  they  even 
harbor  them,  and  may  so  give  rise  to  epidemics  through 
water-infection,  by  the  use  of  latrines  from  which  flies 
may  obtain  the  germs,  and  in  other  ways.  As  stated  in 
the  preceding  chapter,  man  is  the  carrier  of  the  com- 
monest intestinal  worms,  and  it  is  his  ignorance  or 
carelessness  that  is  responsible  for  their  spread.  Persons 
who  spread  tuhercidosis,  tonsillitis,  and  other  troubles 
by  their  careless  spitting  usually  do  it  in  ignorance  of 
the  fact  that  they  are  doing  wrong.  Most  consumptives 
do  not  realize  that  they  have  the  disease  until  after 
they  have  been  expectorating  tubercle  bacilli  for  some 
time.  Other  disease-carriers  who  may  be  quite  ignorant 
of  the  role  they  are  playing  are  sufferers  from  certain 
eye  and  skin  diseases,  such  as  trachoma  or  granular 
lids,  gonorrhosal  inflammation  of  the  eyes,  ringworm, 
itch,  impetigo,  and  many  other  diseases  of  the  skin. 
They  may  either  be  ignorant  that  they  have  any  disease, 
or  that  the  diseases  they  have  are  contagious,  and  so,  by 


DISEASE-CARRIERS  183 

careless  contact,  the  use  of  public  towels  or  brushes, 
or  tliose  belonging  to  other  persons,  through  barbers' 
chairs  and  in  other  ways,  they  may  infect  many  persons. 
Nurses  and  doctors  may  at  times  carry  and  trans- 
mit infectious  diseases,  such  as  measles,  smallj^ox  or 
typhoid,  either  innocently,  as  when  a  diagnosis  cannot 
yet  be  made  and  they  do  not  know  of  the  dangerous 
contact,  or  culpably,  as  when  they  know  of  the  danger 
but  do  not  take  proper  precautions  to  guard  against  it. 
Venereal  diseases,  both  gonorrhoea  and  syphilis,  may 
be  innocently  transmitted,  quite  aside  from  any  ques- 
tion of  sexual  intercourse.  A  syphilitic  infant  may  in- 
fect its  nurse  ;  a  girl  may  get  a  chancre  of  the  lip  from 
kissing  a  person  who  has  infective  lesions  in  the  mouth 
and  does  not  know  it ;  or  possibly,  though  it  must  happen 
very  rarely,  by  following  a  syphilitic  in  the  use  of  a  com- 
munion cup  or  other  public  drinking-vessel;  doctors  oc- 
casionally become  infected  with  syphilis  through  needle- 
pricks  or  slight  scratches  that  become  infected  during 
operations.  A  child  may  contract  gonorrhoea  from  sleep- 
ing with  or  against  its  infected  mother,  or  an  infant's 
eyes  may  be  infected  during  its  birth,  and  others  may 
become  infected  through  handling  it.  Many  men  who 
thought  themselves  quite  free  from  all  venereal  disease 
have  infected  their  innocent  wives  through  sexual  in- 
tercourse, and  every  man  who  has  ever  had  venereal 
disease  should  seek  the  examination  and  opinion  of  a 
competent  physician  before  entering  the  married  state. 
The  company  officer  cannot  be  expected  to  recognize 
the  various  disease-carriers  in  his  company,  but  he  can 
aid  in  their  detection  if  he  sees  that  all  sick  men  report 
promptly  to  the  surgeon,  and  that  they  remain  on  sick 
report  until  no  longer  sources  of  danger.  Occasionally 


184  THE   CAUSES   OF   DISEASE 

a  company  officer  takes  the  unreasonable  view  that  a 
man  who  is  able  to  do  a  bit  of  window-washing-  or  other 
light  work  about  the  hospital  should  be  sent  to  his  com- 
pany. Such  action  might  result  most  seriously  both  to 
the  company  and  the  man,  and  the  wise  company  com- 
mander will  very  rarely,  if  ever,  clamor  for  a  sick  man. 
Even  diseases  not  directly  transmissible,  such  as  malaria, 
constitute  a  menace  in  barracks,  and  the  victims  are, 
ordinarily,  not  only  better  off,  but  also  less  dangerous 
when  in  hospital.  A  man  infested  with  worms  may  be 
capable  of  working  and  may  desire  to  do  duty,  but  he 
cannot  be  so  well  treated  elsewhere  as  in  hospital,  nor 
will  the  disposal  of  his  stools  be  so  well  looked  after 
if  he  be  free  to  go  and  to  defecate  where  he  pleases. 

Certain  diseases  are  derived  exclusively  or" almost  so 
from  animals.  Among  them  are  many  very  dangerous 
.  infections,  some  of  them  quite  incurable. 

.  We  will  consider  some  of  these. 

Hydropliohia  is  a  disease  that  affects  a 
great  many  kinds  of  animals  and  is  almost  uniformly 
fatal.  It  is  ordinarily  considered  a  disease  of  the  dog 
family,  but  there  is  some  reason  to  believe  that  it  is 
naturally  a  disease  of  certain  herbivora,  especially  rab- 
bits, and  the  dog  contracts  it  from  these.  So  far  as  man 
is  concerned,  however,  it  may  be  considered  as  origi- 
nating with  the  biting  animals,  especially  the  dog^ 
wolf,  fox,  cat,  and  skunk.  By  these  it  may  be  trans- 
mitted to  horses,  cattle,  and  other  domestic  animals, 
and  to  man  himself.  No  cure  is  known  for  the  disease 
after  it  has  actually  begun,  but  if  treatment  be  begun 
soon  after  infection,  immunity  may  be  established  be- 
fore the  incubation  period  has  ended,  and  the  onset 
thus  prevented.    As  there  are  three  prevalent  errors 


DISEASE-CARRIERS  185 

regarding  this  disease,  each  fraught  with  the  possibility 
of  serious  consequences,  they  will  be  briefly  discussed 
here. 

The  first  of  them  is  the  somewhat  widespread  belief 
that  the  disease  does  not  exist,  that  its  victims  really 
die  from  fright.  This  is  abundantly  disproved  by 
the  deaths  of  people  who  were  not  frightened,  who  for 
weeks  or  months  had  forgotten  the  incident  of  the  bite ; 
by  the  ability  to  infect  and  kill  rabbits,  dogs,  and  other 
animals,  by  inoculation  from  animals  dead  of  rabies 
but  not  from  those  dying  of  other  diseases ;  by  the  in- 
fection and  death  of  cattle,  horses,  and  men  ;  by  the 
bites  of  rabid  animals,  but  of  no  others  ;  and  in  other 
ways.  Hydropliohia  exists. 

The  second  error  relates  to  the  diagnosis  of  the  dis- 
ease in  the  dog.  Not  every  dog  that  slobbers  and  bites 
is  rabid,  and  it  is  senseless,  as  well  as  cruel,  to  start  a 
howling  mob  after  it  and  pound  it  to  death  on  suspicion. 
The  disease  usually  begins  in  the  dog  with  a  change  of 
disposition,  usually  shown  by  restlessness  and  irrita- 
bility; the  animal  is  easily  startled,  or  crouches  in  fear. 
The  appetite  may  fail  or  there  may  be  difficulty  in 
chewing  or  swallowing  food.  Drinking  is  less  interfered 
with,  and  the  name  hydrophobia  (fear  of  water)  is  not 
accurately  descriptive.  Change  in  the  bark  or  absence 
of  barking  is  often  noted.  Later,  the  animal  may  show 
a  tendency  to  tear  and  swallow  foreign  bodies,  and  to 
snap  at  things  in  its  vicinity  or  at  phantoms  of  its  dis- 
ordered brain.  This  may  be  followed  by  a  furious  stage, 
when  the  dog  "runs  mad."  Always  the  disease  ends  in 
paralysis,  usually  first  showing  in  the  muscles  concerned 
in  swallowing,  later  of  the  hind-quarters,  the  jaw,  and 
the  entire  body,  death  coming  in  from  four  to  seven  days 


186  THE   CAUSES  OF   DISEASE 

after  the  onset.  The  disease  probably  begins  with  the 
invasion  of  the  dog's  brain  by  the  parasites,  and  the 
saliva  is  not  always  dangerous  at  the  beginning.  The 
diagnosis  can  be  properly  made  only  by  observation  of 
the  whole  course  of  the  disease,  or  by  examination  of  the 
animal's  brain.  Therefore,  the  correct  course  of  pro- 
cedure is  either  to  capture  the  dog  and  confine  it  so 
that  the  disease  may  be  observed,  or  to  kill  it  and  at 
once  cut  off  its  head  and  send  that  to  a  competent 
pathologist  fior  examination. 

The  third  error  relates  to  treatment  of  bitten  per- 
sons. It  is  computed  that  about  one  sixth  of  the  persons 
bitten  by  rabid  animals  develop  hydrophobia,  the  rest 
escaping  because  the  saliva  was  not  at  the  time  infec- 
tious, because  the  clothing  wiped  all  saliva  from  the 
biting  teeth,  and  for  other  reasons.  Nevertheless,  the 
sixth  that  do  develop  the  disease  always  die,  and  proper 
preventive  treatment  is  essential.  This  consists  in  the 
cleansing  of  the  wound  with  heat  or  antiseptics,  the  pro- 
motion of  bleeding,  proper  dressing,  and  the  Pasteur 
treatment  for  the  establishment  of  immunity.  "  Mad- 
stones  "  and  charms  are  quite  useless. 

Glanders  is  well  known  as  a  disease  of  horses  and 
mules,  less  so  as  a  cause  of  human  illness.  Neverthe- 
less, human  beings  do  contract  it,  usually  with  fatal 
results.  Its  contagious  and  fatal  characters  are  so  well 
recognized  in  the  army,  that  its  presence  constitutes 
proper  grounds  for  the  destruction  of  animals,  even 
though  their  usefulness  is  not  yet  greatly  impaired.  The 
persons  who  most  often  contract  it  are  those  concerned 
in  the  care  and  treatment  of  horses.  As  the  disease  in 
its  early  stages  may  not  present  characteristic  or  well- 
marked  symptoms,  it  may  be  mistaken  for  a  "  cold," 


DISEASE-CARRIERS  187 

quinsy,  or  other  less  dangerous  malady,  and  the  animal 
be  handled  or  treated  without  the  observation  of  proper 
precautions  to  prevent  infection.  Special  care  should 
always  be  exercised  to  prevent  any  discharge  from  the 
nose  or  from  sores  on  horses  coming  in  contact  with 
wounds,  scratches,  or  the  respiratory  tract,  and  to  keep 
the  animal  from  blowing  its  nasal  discharge  or  saliva 
into  the  face  of  one  examining  it.  All  suspected  ani- 
mals should  be  isolated  and  handled  as  though  known  to 
be  glandered  until  the  diagnosis  is  settled.  The  disease 
may  also  be  contracted  from  handling  dead  animals 
during  their  removal,  or  in  the  course  of  post-mortem 
examination,  and  proper  precautions  as  to  cleanliness, 
avoidance  of  wounds,  and  disinfection  should  be  ob- 
served. Glanders  and  farcy  are  different  forms  of  the 
same  disease,  are  due  to  the  same  organism,  and  must 
be  treated  with  equal  respect. 

Plague  or  the  j)est  is  one  of  the  most  serious  and  im- 
portant diseases  for  which  man  owes  a  debt  of  hatred 
and  warfare  to  his  animal  neighbors.  It  has  not  as  yet 
gained  an  extensive  footing  in  our  own  country,  but  it 
has  maintained  a  slight  hold  in  San  Francisco  for  several 
years,  has  appeared  in  a  few  other  Pacific  coast  cities, 
and  has  worked  some  havoc  among  such  near  neighbors 
as  Peru,  Venezuela,  the  Argentine,  Brazil,  Mexico,  and 
the  Azores ;  so  that  we  may  s^e  much  of  it  in  a  few  years 
if  the  greatest  and  most  unremitting  care  is  not  exer- 
cised. It  has  prevailed  extensively  in  the  Philippines, 
though  it  now  seems  under  good  control  there,  while  in 
India,  China,  and  other  oriental  countries  it  has  caused 
many  millions  of  deaths.  Its  prevalence  and  extension 
in  India  are  such  at  the  present  time  as  to  be  causing 
the  abandonment  of  large  tracts  of  country  and  of  whole 


188  THE   CAUSES   OF  DISEASE 

villages,  and,  if  reports  be  true,  to  threaten  the  very 
existence  of  the  government.  The  investigations  of  the 
British  commission  appointed  to  study  the  disease  in 
India  show  clearly  that  epidemics  of  human  plague  arise 
after  and  in  consequence  of  epizootics  of  rat  jplague. 
The  infection  is  transmitted  from  rats  to  man  hy  Jleas^ 
usually  those  of  the  rat,  and  the  relation  of  the  epidemics 
to  the  epizootic  is  beautifully  shown  as  follows :  There 
are  two  principal  species  of  rat  concerned  there,  the 
brown  or  Norway  rat  and  the  black  or  house  rat,  the 
former  also  known  as  the  ship  and  the  sewer  rat.  It  is 
among  that  class  that  the  epizootic  arises,  usually,  and 
in  about  7.2  days  later  it  is  also  prevailing  among  the 
house  rats.  This  7.2  days  is  accounted  for  by  the  fact 
that  it  is  also  the  average  experimental  time  elapsing 
between  the  biting  of  the  black  rat  by  an  infected  flea 
and  the  death  of  the  animal.  (The  rise  of  the  epizootic 
is  measured  by  the  numbers  of  rats  found  dead  or  dy- 
ing.) The  black  rat  epizootic  precedes  the  height  of  the 
human  epidemic  by  from  ten  to  fourteen  days,  a  period 
accounted  for  as  follows :  The  rat  flea  does  not  readily 
attack  man  until  starved  for  three  days.  The  incubation 
period  of  human  plague  is  about  three  days.  The  dura- 
tion of  the  fatal  human  plague  averages  four  and  a  half 
days.    Average  total,  eleven  and  a  half  days. 

The  relationship  between  rats  and  human  plague  is 
also  proved  in  other  ways,  but  they  cannot  be  discussed 
here.  The  fact  is  established,  and  it  constitutes  the 
most  important  of  the  many  reasons  why  man  should  be 
at  enmity  with,  and  try  to  exterminate,  rats. 

It  must  be  borne  in  mind,  however,  that  other  ani- 
mals may  be  infected,  and  recently  wild  squirrels  have 
been  shown  to  have  the  disease  in  California.    They 


DISEASE-CARRIERS  189 

and  gophers,  prairie  dogs,  and  similar  animals  may  yet 
play  an  important  part  in  disseminating  it.  While  dirt 
and  unsanitary  conditions  cannot  give  rise  to  plague, 
their  influence  in  promoting  the  presence  and  increase 
of  both  fleas  and  rats  is  so  well  recognized  that  it  is 
well  to  mention  the  matter  as  showing  how  they  may 
strongly  predispose  to  disease  that  they  cannot  cause 
directly. 

Tuberculosis  is  the  most  prevalent  disease  affecting 
man,  and  is  responsible  for  more  deaths  than  any  other 
one  cause.  It  is  also  a  common  disease  of  cattle  and  of 
some  other  animals,  and  it  may  be  transmitted  to  man 
from  them.  Tuberculous  meat,  if  not  sufficiently  cooked 
to  sterilize  it,  may  be  the  medium  of  infection,  but  milk 
is  probably  even  more  commonly  the  carrying  agent.  A 
cow  that  has  tuberculous  disease  of  the  udder  may  give 
off  immense  numbers  of  bacilli,  and  these  may  be  in- 
gested in  a  virulent  condition  in  milk,  cream,  butter,  or 
cheese.  This  method  of  infection  is  so  common  that  some 
authorities  who  have  devoted  great  study  to  the  subject 
contend  that  it  is  the  usual,  if  not  the  exclusive  method, 
and  they  relegate  infection  by  inhalation  to  a  place 
of  very  minor  importance.  Such  a  view  is  extreme  and 
probably  not  correct,  as  shown,  for  instance,  by  the  fact 
that  tubei'culosis  is  very  prevalent  in  Japan  and  other 
far  eastern  countries  where  neither  milk  nor  beef  is 
a  common  article  of  food.  Nevertheless,  infection  by 
means  of  these  food-articles  can  and  does  occur,  and  the 
precautions  against  the  sale  of  tuberculous  meat  and 
milk  are  wise  and  salutary.  Wild  or  range  cattle  are 
much  less  subject  to  the  disease  than  high-bred,  stabled 
cattle,  and  many  other  animals  that  suffer  from  it  in 
captivity  are  free  from  it  in  their  native  wild  state,  thus 


190  THE   CAUSES  OF  DISEASE 

showing  the  predisposing  influence  of  confinement  and 
bad  air. 

Tuberculosis  is  rather  common  also  in  pigs,  dogs,  and 
cats,  less  so  in  sheep  and  goats.  The  disease  may  be 
transmitted  by  the  flesh  of  pigs.  Pet  animals,  such  as 
dogs  and  cats,  are  apt  to  contract  and  spread  the  infec- 
tion because  of  their  habits  of  licking  up  sputum  and 
other  discharges  to  which  they  may  have  access.  This 
furnishes  another  argument  for  the  proper  care  and 
destruction  of  all  tuberculous  discharges.  The  urine  and 
fecal  discharges  of  men  or  animals  that  have  tubercu- 
losis may  contain  the*  bacilli  and  may  constitute  serious 
dangers.  Thus  a  cow  that  is  passing  the  germs  in  these 
ways  may  indirectly  infect  sound  cattle  or  their  milk  by 
means  of  bacilli  blown  about  the  stable  with  the  dust  of 
dried  feces  or  urine. 

Fish  and  birds  also  have  tuberculosis,  but  it  is  doubt- 
ful if  the  forms  of  it  that  they  have  can  be  transferred 
to  man.  It  is  not,  however,  necessary  to  go  to  the  ex- 
treme lengths  that  fear  may  carry  one  in  the  efforts  to 
avoid  tuberculosis.  Patients  with  the  disease  need  to  be 
taught  to  take  proper  precautions  as  to  the  disposal  of 
their  spit  and  other  excreta,  but  when  they  take  such 
precautions  they  need  not  be  avoided.  Tuberculous  milk 
is  best  avoided,  but  if  the  milk  is  not  known  to  be  in- 
fected, but  is  merely  of  unknown  ^r  doubtful  origin,  it 
can  be  rendered  safe  by  boiling  or  pasteurization.  The 
indiscriminate  sale  of  tuberculous  meat  is  properly  for- 
bidden by  law ;  but  if  an  animal  is  not  badly  diseased 
and  the  visibly  injured  portions  of  the  carcass  are  re- 
jected, the  rest  can  be  eaten  with  safety  if  it  is  first 
properly  cooked.  Such  meat  is  not  purchased  for  the 
army,  however,  and  the  above  statement  is  made  for  its 


DISEASE-CARRIERS  191 

general  worth  and  not  to  encourage  the  acceptance  of 
inferior  stores. 

Anthrax  is  a  disease  that  causes  a  very  great  number 
of  deaths  in  cattle  and  sheep  in  various  parts  of  the 
world.  Other  animals  are  also  susceptible  to  it  in  vary- 
ing degrees,  among  them  being  horses,  deer,  pigs,  mice, 
and  rabbits.  Man  suffers  from  it  in  two  or  three  forms, 
generally  obtaining  his  infection  from  the  hides  of  ani- 
mals dying  of  it.  Wool-sorters  and  hide-handlers  are 
therefore  particularly  subject  to  it,  and  one  common 
name  of  the  trouble  is  "  wool-sorters'  disease."  Soldiers 
have  also  been  known  to  be  infected  (though  not  in  our 
army)  through  the  use  of  sheepskin-lined  coats,  or  boots 
made  of  poorly  cured  leather.  The  disease  is  often  fatal, 
and  materials  from  animals  dead  of  it  should  not  be 
used.  It  is  caused  by  one  of  the  spore-forming  bacilli, 
and  the  spores  are  very  resistant  to  both  heat  and 
chemicals.  Human  infection  takes  place  in  two  ways : 
through  cuts  or  abrasions  brought  into  contact  with  in- 
fected skins,  carcasses,  or  other  matters,  and  by  inhala- 
tion of  hairs,  bits  of  wool,  or  dust  that  carry  the  spores. 

Man  is  the  occasional  subject  of  some  other  diseases 
of  animals,  and  it  is  a  good  general  rule  to  take  as  much 
care  to  prevent  infection  from  a  sick  animal  as  from  a 
sick  person,  unless  the  disease  is  known  to  be  one,  such 
as  rinderpest,  to  which  persons  are  not  liable. 

Domestic  animals  are  also  occasional  carriers  of  com- 
mon human  diseases.  Dogs  and  cats  have  been  known 
to  have  diphtheria.  Cats  have  been  experimentally  in- 
fected with  whooping-cougli,  and  there  is  reason  to 
suspect  that  either  of  these  animals  might  carry  the 
contagium  of  such  diseases  as  smallpox,  scarlet  fever, 
or  measles  in  its  hair.    The  liability  of  getting  ring- 


192  THE   CAUSES   OF   DISEASE 

worms  and  other  skin  diseases,  as  well  as  lice  and  fleas, 

from  domestic  animals  has  already  been  mentioned. 

Insects  of  different  kinds  transmit  diseases  in  various 

ways.  The  first  and  simplest  way  is  by  acting  as  simple 

_  ^  carriers.  Thus  oremis  become  attached  to 
InsGCt  . 

^       .  the  lesrs  and  bodies  of  flies  aliofhting  on 

C&i'iriGi'S  o         o 

an  infected  wound  or  a  yaws  paj^ule,  and 

these  by  later  alighting  on  clean  wounds  or  abrasions 
may  leave  the  germs  there  and  cause  infection.  Or 
the  transfer  may  be  less  direct,  as  in  the  case  of  the 
fly  that  goes  from  a  typhoid  stool  to  a  food-article  and 
there  leaves  germs  to  be  later  ingested  with  the  food. 
In  other  instances  the  simple  deposit  of  the  germs  may 
not  insure  infection,  but  the  irritation  caused  by  the 
insects  may  further  it.  This  is  well  shown  in  the  case 
of  plague.  The  flea  transmitting  that  disease  may  do  so 
by  reason  of  the  fact  that  the  germs  are  adhering  to  its 
mouth-parts  and  ai^e  introduced  directly  by  the  biting 
act.  On  the  other  hand,  the  mouth  and  external  parts 
of  the  flea  may  be  free  from  germs,  in  which  case  in- 
fection may  occur  as  follows :  The  flea  has  a  habit  of 
defecating  while  it  sucks  blood,  probably  to  make  room 
for  a  larger  meal,  and  in  so  doing  it  may  deposit  plague- 
germs  on  the  skin,  near  but  not  in  the  wound.  If,  now, 
the  bite  is  rubbed  or  scratched,  as  is  often  the  case,  the 
germs  may  in  that  way  get  into  the  wound  and  infection 
be  assured.  More  complicated  processes  are  involved  in 
other  instances,  as  in  malaria,  yellow  fever,  or  filariosis, 
in  which  the  parasites  must  undergo  a  cycle  of  develop- 
ment in  the  insect,  and  the  latter  cannot  transmit  the 
disease  until  a  sufficient  time  has  elapsed  to  allow  that 
to  occur.  Some  insects  can  transmit  germs,  and  the 
capacity  to  convey  infection  to  man  or  other  animals, 


DISEASE-CARRIERS  193 

to  their  offspring.  This  fact  has  long  been  known  re- 
garding the  tick  that  transmits  Texas  fever  to  cattle, 
and  it  has  recently  been  proven  true  as  to  those  infect- 
ing man  with  the  spotted  or  tick  fever  of  Montana  and 
the  relapsing  or  tick  fever  of  Africa.  These  diseases 
may  be  transmitted  by  the  bites  of  ticks  raised  from 
the  eggs  of  those  biting  infected  persons,  but  which 
have  not  themselves  ever  bitten  people  or  had  any  other 
chance  than  through  heredity  to  obtain  the  infec- 
tion. It  is  regarded  as  possible  that  malaria-bearing 
mosquitoes  may  possess  the  same  characteristic,  and 
it  is  probably  true  of  some  other  insects.  Among 
proved  or  probable  insect-carriers  of  general  diseases 
may  be  mentioned  Jlies  of  various  kinds,  several  spe- 
cies of  mosquitoes,  fleas,  lice,  bedbugs,  ticks,  mites, 
and  roaches. 

Among  inanimate  carriers  of  disease,  flood,  water, 
and  milk  have  already  been  mentioned  several  times. 

They  may  serve  as  the  conveying  media  _ 

£  4.-    11      11  •  r    ^-       i.1   1  Inanimate 

tor  practically  all  mfections  that  can  occur  ^ 

through  the  alimentary  canal,  including 
such  important  ones  as  tuberculosis,  typhoid,  cholera, 
dysentery,  diphtheria,  scarlet  fever,  and  many  others. 
These  articles,  and  milk  especially,  offer  such  opportu- 
nities for  the  multiplication  of  bacteria  that  they  may 
convey  to  the  consumer  many  thousand  times  as  many 
germs  as  originally  had  entrance  to  them.  Thus  a  can 
of  milk,  becoming  infected  with  a  few  hundred  typhoid 
bacilli  from  the  hands  of  a  farmer-carrier,  may,  when 
consumed  in  a  city,  ten  or  twelve  hours  later,  have 
billions  of  germs  in  it,  and  cause  a  great  many  cases 
of  the  disease.  It  is,  therefore,  important  to  prevent 
the  access  of   even  one  disease-germ  to  such  articles, 


194  THE  CAUSES  OF  DISEASE 

and  carelessness  in  their  handling  should  not  be  con- 
doned. Fortunately,  thorough  cooking  will  destroy 
disease-germs  in  all  of  these  substances,  a  fact  borne 
out  by  the  relative  immunity  to  cholera  shown  by  the 
Chinese  in  the  Philippines.  They  suffer  in  much  less 
proportion  from  that  disease  than  do  Filipinos,  Euro- 
peans, or  even  Americans,  a  fact  accounted  for  by  the 
Chief  of  the  Bureau  of  Health  by  the  statement  that 
they  eat  and  drink  practically  nothing  uncooked.  In 
nearly  all  other  respects  their  sanitary  environment  is 
bad. 

Clothing^  hooks^  carpets,  and  other  personal  or  house- 
hold goods  that  have  been  used  or  handled  by  persons 
ill  with  such  diseases  as  smallpox,  measles,  and  scarlet 
fever  may  convey  infection,  and  for  that  reason  the 
disinfection  or  destruction  of  such  articles  is  resorted 
to  as  a  means  of  preventing  the  spread  of  contagion. 
Such  articles  as  can  be  boiled  or  thoroughly  steamed 
can  be  quite  well  disinfected ;  but  if  facilities  are  not 
at  hand  for  sterilizing  such  large  articles  as  mattresses, 
they  may  need  to  be  destroyed.  Boots,  hats,  and  cer- 
tain other  classes  of  articles  will  not  stand  steaming, 
and  will  have  to  be  disinfected  with  chemicals  or  de- 
stroyed. 

Such  articles  of  personal  belongings  are  also  common 
carriers  of  the  organisms  of  suppuration.  So  widespread 
are  such  germs  that  almost  everything  in  common  use 
has  them  on  it;  and  if  brought  into  contact  with  a 
wound  they  will  leave  the  article  and  start  infection. 
This  alone  makes  the  sterilized  and  sealed  first-aid 
packet  of  so  much  greater  value  than  articles  of  cloth- 
ing and  handkerchiefs  as  first  dressings  for  wounds. 
The  packets,  if  not  contaminated  by  handling,  practi- 


DISEASE-CARRIERS  .        195 

cally  never  cause  infection ;  the  other  articles  almost 
always  do  so.  Nails,  bullets,  knives,  and  other  missiles  or 
weapons  that  have  not  been  sterilized  may  infect  the 
wounds  they  cause  ;  or,  if  sterile  themselves,  may  carry 
infection  from  the  skin  or  clothing  they  traverse. 


PART  III 

THE  PREVENTION  AND  CONTROL 
OF  EPIDEMICS 


"  Thou  shall  not  be  afraid  .  .  .  for  the  pestilence  that  walketh  in 
darkness :  nor  for  the  destruction  that  wasteth  at  noonday." 

Psalm  91  :  56 


CHAPTER  XI 

THE   DEFENSES   AGAINST   DISEASE    IN   GENERAL 

Fortunately  for  the  human  race,  the  contracting 
and  development  of  disease  are  somewhat  difficult  mat- 
ters, and  only  follow  the  coincident  occurrence  of  cer- 
tain trains  of  circumstances.  They  may  be  compared 
with  the  defeat  of  an  army,  for  which  purpose  it  is 
necessary  that  the  army  be  weakened  by  loss  of  men, 
hard  marching,  lack  of  food,  exposure,  or  other  cause ; 
or  that  the  enemy  has  been  able  to  bring  a  superior 
force  on  the  field,  that  his  supplies  are  better  or  are 
more  promptly  delivered  ;  that  one  side  improves  its 
opportunities  for  offense  or  defense  and  the  other  does 
not ;  or  that  other  good  and  sufficient  reasons  are  pre- 
sent. The  mere  existence  or  contact  of  two  armies  does 
not  explain  that  a  certain  one  of  them  is  defeated.  So 
in  the  matter  of  sickness,  the  mere  existence  or  contact 
of  a  man  and  typhoid  organisms  is  not  in  itself  suffi- 
cient to  insure  that  the  man  has  or  will  get  typhoid 
fever.  For  that  purpose  it  is  necessary  that  the  germs 
shall  be  alive,  virulent,  and  capable  of  development, 
that  they  shall  gain  entrance  to  the  body  of  the  man 
in  sufficient  numbers,  that  the  man's  body  shall  be 
unable  to  destroy  them  before  they  have  time  to  de- 
velop and  liberate  their  poisons,  and  that  his  tissues 
shall  unite  with  such  poisons  after  they  are  liberated. 
It  is  relatively  rare  that  these  conditions  coexist,  and 
typhoid  fever  is  therefore  not  more  common  than  it  is. 
Our  defense  against  sickness  then  rests  on  our  ability 


200       THE   PREVENTION   OF  EPIDEMICS 

to  break  or  destroy  the  chain  of  disease-favoring  cir- 
cumstances. If  we  can  entirely  destroy  it,  we  are  gure 
to  remain  well,  but  if  we  cannot  do  that,  the  destruction 
of  one  link  may  save  us.  It  is  well,  therefore,  that  we 
should  first  consider  general  plans  of  defense  or  aggres- 
sion, and  later  pass  to  the  discussion  of  special  cam- 
paigns or  battles. 

The  body  is  defended  from  disease  by  many  natural 

factors,  and  we  should  try  to  preserve  these  intact.  The 

skhi  presents  an  impassable  barrier  to  most 

atura  organisms,  and  very  few  infections  can 
enter  through  it  as  long  as  it  remams  un- 
^  broken.  It  has  weak  points,  however,  and 

^  infections  may  occur   in  the  hair-follicles 

or  in  the  skin-glands.  Boils  are  the  commonest  results 
of  such  invasions.  The  organisms  of  typhoid,  tubercu- 
losis, and  many  other  diseases  could  be  put  on  the 
sound  skin  with  impunity,  if  they  did  not  later  gain 
entrance  to  the  nose,  mouth,  wounds,  or  other  openings. 

The  mucous  membranes  are  all  warm  and  moist,  and, 
in  that  way,  offer  favorable  conditions  for  bacterial 
growth ;  but  they  are  all  covered  with  mucus  to  which 
the  germs  may  adhere,  and  with  which  they  may  be 
passed  out  of  the  body  by  spitting  or  otherwise.  The 
cells  lining  some  mucous  surfaces  have  little,  moving, 
hair-like  projections,  and  by  means  of  these  are  able  to 
pass  along  and  expel  small  foreign  bodies  getting  on 
them. 

The  gastric  juice  is  sufficiently  acid  to  destroy  many 
varieties  of  micro-organisms,  and  digestive  disturbances 
that  lessen  that  acidity  increase  the  liability  to  infec- 
tion. The  fluid  also  has  the  power  of  neutralizing  or 
digesting  some  poisonous  products,  but  not  all. 


DEFENSES   AGAINST   DISEASE  201 

The  urine,  by  its  acidity  and  its  irrigating  and 
cleansing  action,  doubtless  has  an  effect  in  keeping 
down  the  number  of  cases  of  venereal  diseases. 

The  prompt  reaQtion  to  irritation  is  often  a  disease- 
preventing  factor.  A  dose  of  arsenic  or  a  meal  of  tainted 
meat  may  produce  such  prompt  vomiting  as  to  cause 
the  expulsion  of  all  poison,  and  so  prevent  further  symp- 
toms. The  inflammatory  reaction  following  the  infection 
of  wounds  is  usually  a  conservative  process  that  limits 
the  infection  to  the  locality  of  the  wound,  and  prevents 
its  diffusion  through  the  body. 

As  stated  before,  however,  a  man  may  possess  an 
imnmnitij  to  certain  diseases  even  though  the  germs 
gain  entrance  to  his  body  in  the  numbers  Xynrn  i 
and  of  the  virulence  ordinarily  producing  „-4.-,9 
such  diseases.  This  may  be  hereditary  or 
'•'•  natiiraV  ^  immunity,  when  the  man  is  born  without 
susceptibility  to  the  disease.  It  is  acquired  when  due 
to  something  occurring  after  birth.  Acquired  immunity 
is  usually  due  to  an  attack  of  the  disease,  and  is  well 
recognized  in  such  affections  as  smallpox,  measles,  scar- 
latina, and  typhoid.  It  is  common  knowledge  that  one 
attack  of  any  of  these  usually  protects  against  a  second. 
This  is  also  known  as  active  immunity,  because  the 
body  is  active  in  maintaining  it.  Passive  immunity  is 
due  to  the  introduction  into  the  body  of  ready-made  im- 
munizing substances,  such  as  diphtheria  antitoxin,  that 
is  contained  in  the  blood-serum  of  an  immunized  horse. 
Active  acquired  immunity  may  also  be  induced  by 
vaccination,  the  procedure  whereby  disease-producing 
organisms  in  an  attenuated  or  weakened  state  are  intro- 
duced into  the  body  and  set  up  a  very  mild  form  of 
disease,  but  one  sufficient  to  set  the  body  on  the  de- 


202       THE  PREVENTION  OF  EPIDEMICS 

fensive  and  cause  it  to  produce  immunizing  substances. 
This  procedure  is  best  known  in  its  relation  to  small- 
pox, and  as  that  was  the  disease  for  whose  prevention  it 
was  first  used,  the  name  vaccination  in  the  broad  sense, 
that  is,  the  introduction  of  disease-producing  germs  to 
produce  immunity,  is  taken  from  that  instance.  It  has 
also  been  used,  though,  to  produce  immunity  to  cholera, 
plague,  dysentery,  typhoid  fever,  hydrophobia,  and  sev- 
eral diseases  of  animals,  in  some  instances  with  consid- 
erable success. 

Immunity  may  also  be  relative  or  absolute,  temporary 
or  permanent.  Man's  lack  of  susceptibility  to  the 
pleuro-pneumonia  of  cattle,  for  instance,  is  both  perma- 
nent  and  absolute.  An  attack  of  smallpox  may  produce 
an  immunity  that  is  either  j^&rmanent  or  temporary.  In 
the  latter  instance  the  sufferer  might  have  a  second 
attack  after  some  years.  A  relative  immunity  to  typhoid 
might  protect  against  a  small  number  of  bacteria,  but 
not  against  a  very  large  number. 

Immunity  is  due  to  several  factors,  not  all  of  which 
are  understood.  In  regard  to  some  diseases,  such  as 
diphtheria  and  tetanus,  it  is  due  to  the  development  of 
antitoxin,  a  substance  that  acts  as  a  direct  antidote  to 
the  poison  of  the  disease  and  neutralizes  its  effects.  In 
other  instances,  as  in  the  case  of  plague,  cholera,  and 
typhoid,  it  is  largely  due  to  the  presence  or  develop- 
ment of  substances  that  kill  or  dissolve  the  bacteria. 
In  many  instances  it  is  partly  or  entirely  due  to  the 
activity  of  certain  cells,  phagocytes,  that  take  up  and 
destroy  the  germs.  Absolute  hereditary  immunity  may 
be  due  to  none  of  these,  but  to  lack  on  the  part  of  the 
body  cells  of  chemical  groups  that  enable  the  poisons 
to  enter  into  combination  with  them. 


DEFENSES  AGAINST   DISEASE  203 

Relative  immunity  is  maintained  by  those  conditions 
that  keep  up  the  general  health  and  maintain  the  re- 
sistance of  the  body.  It  is  lowered  by  causes     „  , 

that  depress  these,  such  as  starvation,  ex-     __     ... 
.       .   .     .        1.1  II!      Healtn 

haustion,  injuries,  shocks,  worry,  and  griei. 

It  is  therefore  important  that  the  man  and  his  environ- 
ment be  constantly  kept  at  their  best,  that  abundant 
and  proper  food,  pure  water,  good  air,  and  right  clothing 
be  provided,  that  sufficient  exercise  to  keep  the  respira- 
tion, circulation,  digestion,  and  excretion  active  be 
taken;  that  overwoik,  improper  food,  alcoholic  and 
venereal  excesses,  and  the  entire  list  of  things  predis- 
posing to  disease  be  avoided. 

All  of  these  measures  tend  to  strengthen  the  man 
and  put  him  in  good  condition  and  position  for  the 
combat  with  disease ;  and,  as  with  armies,  so  in  this  in- 
stance, the  maintenance  and  strengthening  of  our  own 
forces  is  not  less  important  than  the  weakening  or  hin- 
dering of  the  enemy  ;  and  as  the  possession  of  a  large 
and  well-trained  army  is,  in  these  days,  often  spoken  of 
as  a  "  national  insurance  policy  "  and  a  guarantee  of 
peace,  so  may  the  well- trained  and  sound  body  be  re- 
garded as  insurance  against  disease.  As  the  combat  with 
germs  is,  however,  one  that  never  ceases,  we  must  also 
try  to  injure  the  enemy  as  much  as  possible,  giving 
no  quarter,  as  we  may  expect  none.  We  should  try  to 
eradicate  all  disease-producing  organisms,  to  reduce 
their  numbers  where  we  cannot  do  that,  and  to  weaken 
them  by  every  means  available.  Many  of  the  measures 
designed  to  accomplish  these  ends  have  been  mentioned 
or  discussed  in  preceding  chapters  or  will  be  taken  up 
more  fully  in  later  ones,  but  some  of  them  may  be  con- 
sidered at  length  here  and  not  again  described.  They 


204       THE  PREVENTION  OF  EPIDEMICS 

may  be  classed  in  two  categories  :  measures  designed  to 
prevent  contact  with  the  germs,  and  those  aimed  at 
their  destruction. 

Among  the  former,  avoidance  of  the  sick  may  be 
considered  one  of  the  most  important  measures.    This 
recommendation  cannot  be  taken  as  coun- 
tenancing neglect  of  the  sick  or  lack  of  all 
proper  care  and  attention,  but  it  refers  to 
unnecessary  contact  with   them,  that  due 
to  carelessness,  curiosity,  or  sentimentality.  As  stated 
before,    the  principal    agent  in    the   dissemination  of 
human  diseases  is  man  himself,  and  nearly  every  case  of 
infectious  disease  is  derived  from  another.  Therefore, 
unnecessary  visits  to  hospitals  and  sick-rooms  should  be 
discouraged,  and  in  military  life  it  should  be  axiomatic 
that  sick  men  should  be  removed  from  squad-rooms,  un- 
less good  reasons  to  the  contrary  exist  in  special  cases. 
Hospitals  are  wisely  provided  for  the  reception  of  such 
soldiers,  and  if  many  sick  are  treated  "in   quarters," 
these  large  and  expensive  plants  are  kept  from  jaerf orm- 
ing  one  of  their  important  functions. 

Even  though  the  sick  man  goes  into  a  general  ward 
in  the  hospital,  he  is  less  apt  to  infect  others  there  for 
_.       .,  several  reasons.    One  of  these  is  that  air- 

space and  ventilation  are  more  liberal  there. 
In  the  squad-room,  where  but  six  hundred 
cubic  feet  of  space  are  allowed  each  person,  a  sick  man 
may  seriously  contaminate  the  air.  In  hospital  the  same 
amount  of  contagium  is  dilated  two  to  four  times,  be- 
cause the  space  per  man  is  twelve  to  twenty-four  hun- 
dred cubic  feet.  Naturally  an  exposed  person  breathes 
in  only  one  third  as  many  organisms. 

In  the  more  readily  transmissible  diseases  isolation 


DEFENSES   AGAINST   DISEASE  205 

is  resorted  to  as  a  means  of  insuring  lack  of  contact.  It 

is  necessary  in  the  case  of  such  "  catchino^ "    _     ,     . 
•  1  n  1  i.  £  J    Isolation 

sicknesses  as  smallpox,  scarlet  lever,  and 

measles,  and  its  value  is  being  more  appreciated  in  ty- 
phoid fever.  The  degree  and  character  of  the  isolation 
vary  with  the  method  and  ease  of  transmission  of  the 
different  diseases.  If  proper  care  is  taken  in  the  dis- 
posal of  excreta,  bath  water,  and  other  waste  material, 
and  in  the  exclusion  of  flies  and  vermin,  typhoid  fever 
can  be  safely  isolated  in  one  room  of  a  house  or  hospital. 
On  the  other  hand,  smallpox  is  so  highly  contagious  that 
it  needs  to  be  treated  in  a  building  or  tent  placed  at  a 
considerable  distance  from  habitation.  In  yellow  fever, 
malaria,  and  dengue,  the  degree  of  isolation  is  not  ne- 
cessarily greater  than  that  afforded  by  the  screening 
necessary  to  exclude  all  mosquitoes  from  the  sick. 

Infectious  diseases  of  various  kinds  have  different 
incuhatio7i  periods.  These  represent  the  time  elapsing 
between  the  occurrence  of  infection,  the  en-  -. 
trance  of  the  germs  into  the  body,  and  . 
the  appearance  of  the  disease.  In  some  cases 
of  cholera,  diphtheria,  and  a  few  other  diseases,  the  in- 
cubation period  may  be  as  short  as  one  day  or  a  few 
hours  ;  while  in  hydrophobia  it  may  extend  many  weeks 
and  possibly  months.  Diseases  also  vary  as  to  length 
of  time  during  which  the  subjects  remain  sources  of 
danger  after  their  apparent  recovery.  Yellow  fever, 
for  instance,  ceases  to  be  dangerous,  to  others  than  the 
patient,  after  the  third  day  of  its  existence ;  while  a 
typhoid  patient  may  continue  to  give  off  immense  num- 
bers of  virulent  organisms  and  constitute  a  source  of 
danger  to  the  community  for  many  years. 

The  term  quarantine,  though  used  in  several  senses, 


206       THE  PREVENTION  OF  EPIDEMICS 

the  oldest  meaning  a  forty-day  period  of  isolation  for 
persons  thought  to  be  possible  subjects  of  disease,  is  now 
most  commonly  used  to  indicate  the  isolation  of  persons 
thought  to  belong  to  the  two  classes  just  discussed,  and 
of  others  who  have  been  exposed  to  disease  and  may 
belong  to  one  or  the  other.  It  is  usually  understood  to 
mean  the  isolation  of  healthy  persons  as  well  as  the 
sick.  Employed  rationally  and  under  sound  medical 
advice,  it  is  often  a  valuable  measure  and  may  prevent 
epidemics.  But  it  is  always  attended  with  hardship  to 
its  subjects,  and  when  controlled  by  laymen  actuated  by 
panic,  fear,  or  malice,  it  may  become  an  instrument  of 
cruelty  and  oppression.  Only  trained  medical  officers 
should  direct  or  control  systems  of  quarantine,  and  their 
training  should  be  relied  upon  to  suit  the  system  to 
the  circumstances.  A  fixed  isolation  period,  say  of  one 
month,  for  yellow  fever  and  scarlet  fever,  would  be  wrong 
in  both  instances,  but  in  the  one  the  patient  would  be 
unjustly  treated,  in  the  other,  the  public. 

In  addition  to  the   matters  of  barrack,  camp,  and 
kitchen  police  already  discussed,  larger  schemes  of  po- 
licing or  engineering  are  important  in  the 
prevention  of  disease.  These  embrace  such 
diverse  measures  as  the  construction  of  fil- 
°^  °    tering  plants  and  water-systems  to  furnish 

an  abundance  of  pure  water,  the  installation 
of  sewerage-systems  and  crematories  for  the  removal  or 
destruction  of  waste,  thorough  policing  and  cleaning  of 
streets  and  neighborhoods  to  keep  down  dust  or  reduce 
vermin,  or  the  draining,  filling,  or  oiling  of  marshes  to 
do  away  with  mosquitoes. 

The  best  known  and  most  commonly  employed  mea- 
sures for  killing  germs  are  usually  spoken  of  as  disin- 


DEFENSES    AGAINST   DISEASE  207 

fection  and  sterilization.    The  terms  are  not  synony- 
mous, though  often  used  as  if  they  were.     T\ar\fec 

When  an  article  is  sterile  in  the  bacterio-     . .  » 

1.1  •    •   r       f  T-\-       tion  ana 

logical  sense,  it  is  free  from  all  germs.  Uis-     g       .,. 

infection  may  free  it  from  all  germs,  but  _a*-Q„ 
does  not  necessarily  do  so.  It  means  the 
destruction  of  infectious  organisms.  A  urinal  or  bed- 
pan contaminated  by  use  by  a  typhoid  patient  might 
be  disinfected  by  simply  rinsing  in  hot  water,  as  the 
typhoid  germs  are  killed  in  a  few  minutes  by  a  tem- 
perature of  70°  C.    It  would  certainly  not  be  sterile. 

Heat  is  the  most  reliable  of  the  means  of  sterilization 
of  small  inanimate  objects.  It  may  be  applied  moist  or 
dry,  the  former  effective  at  much  lower  degrees  than 
the  latter.  Boiling  water  or  streaming  steam,  both  of 
which  have  a  temperature  of  100  C,  will  destroy  all 
kinds  of  growing  germs  in  a  short  time,  while  dry  heat 
of  200°  C.  is  necessary  to  accomplish  the  same  purpose. 
As  this  temperature  will  burn  fabrics  and  is  dangerous, 
it  is  not  much  used.  Boiling  is  simple  and  is  easily  ap- 
plied to  small  articles,  so  that  it  is  commonly  resorted 
to  where  special  appliances  are  not  available.  In  hos- 
pitals steam  sterilization  is  more  often  resorted  to,  as 
being  more  convenient  and  not  necessitating  so  much 
handling  and  drying  of  articles.  Large  institutions  also 
have  steam-chests  of  sufficient  size  to  receive  such  bulky 
articles  as  mattresses,  carpets,  and  other  household  fur- 
nishings, which  may  thus  be  quickly  and  thoroughly 
disinfected.  Gases  and  solutions  of  chemicals  are  also 
used  for  disinfecting  ;  the  former  for  rooms,  furnishings, 
or  clothing  that  would  be  injured  by  heat,  and  to  pene- 
trate into  cracks  and  crevices  not  otherwise  accessible. 
As  many  of  these  substances  possess  disagreeable  odors, 


208       THE  PREVENTION   OF  EPIDEMICS 

or  have  the  property  of  destroying  smells,  the  lay  public 
at  times  disj^lays  a  tendency  to  confuse  deodoriza- 
tion  and  fumigation  with  disinfection.  The  three  may 
coexist,  but  they  are  not  the  same,  and  the  words 
should  not  be  used  loosely,  as  such  usage  may  lead  to 
confusion  of  the  processes  and  so  do  harm.  Charcoal  is  a 
good  deodorant,  and  burning  tobacco  or  pyrethrum  may 
furnish  efficient  fumigation  in  ridding  a  house  of  mos- 
quitoes, but  none  of  these  is  disinfectant.  The  principal 
gaseous  disinfectants  are  chlorine,  sulphur  fumes,  and 
formaldehyde.  All  of  them  are  very  irritant  and  un- 
suitable for  use  in  efficient  concentration  in  rooms  or 
places  where  they  will  be  inhaled. 

Chlorine  is  not  commonly  used  in  its  gaseous  state, 
and  when  "  chloride  of  lime  "  is  sprinkled  about  it  is 
liberated  in  such  small  amounts  as  to  be  inefficient.  In 
watery  solution  it  is  valuable  in  disinfecting  surfaces  to 
which  it  can  be  applied.  It  is  a  powerful  bleaching 
agent,  and  cannot  be  used  on  fabrics. 

Burning  sulphur  gives  off  fumes  which  unite  with 
water  to  form  sulphurous  acid,  a  very  efficient  disin- 
fectant. The  dry  fumes  have  very  little  virtue  of  the 
kind,  but  are  very  useful  in  destroying  vermin,  such  as 
flies,  mosquitoes,  and  rats.  When  it  is  desired,  however, 
to  disinfect  a  room  that  has  been  occupied  by  a  case 
of  contagious  disease,  such  as  scarlet  fever,  by  means  of 
sulphurous  fumes,  the  walls,  floors,  and  other  surfaces 
should  first  be  moistened  by  wiping  them  with  a  damp 
rag,  or  in  some  other  way.  As  sulphurous  acid  also 
bleaches  or  fades  fabrics,  it  is  frequently  not  to  be  used 
except  at  great  expense. 

Formaldehyde  gas,  or  its  forty  per  cent  solution  in 
water,  known  as  formal  or  formalin,  is  now  more  often 


DEFENSES   AGAINST   DISEASE  209 

used  than  any  other  gaseous  disinfectant.  The  gas  may- 
be generated  in  the  room  to  be  disinfected  by  burning 
wood  alcohol  in  special  burners  known  as  formaldehyde 
generators,  or  it  may  be  liberated  by  the  evaporation  of 
formalin.  The  latter  is  a  very  simple  procedure,  and 
while  its  ejffeetiveness  cannot  be  guaranteed,  the  same 
may  be  said  of  other  gaseous  disinfection,  and  it  is 
often  the  best  available  means.  Many  methods  of  for- 
maldehyde disinfection  have  been  used,  but  only  the  use 
of  formalin  will  be  described  here.  For  disinfecting  the 
contents  of  trunks  and  boxes,  it  may  be  sprinkled  over 
them  freely,  or  placed  on  absorbent  cotton  or  blotting- 
paper  and  the  boxes  then  closed  tightly  for  twenty- 
four  hours.  For  the  disinfection  of  rooms,  from  four 
ounces  to  a  pint  of  formalin  should  be  used  for  each 
thousand  feet  of  cubic  contents.  The  gas  is  speedily 
liberated  if  six  ounces  of  permanganate  of  potash  be 
added  to  the  pint  of  formalin  in  a  large  bowl,  or  if 
unslaked  lime  be  added,  or  if  the  fluid  be  poui-ed  on 
hot  bricks.  A  still  simpler  and  quite  efficient  method, 
however,  is  to  close  hermetically  all  cracks  and  crevices 
about  the  room,  stretch  ropes  or  strings  across  it  and 
on  them  hang  sheets.  The  formalin  is  then  poured  upon 
the  sheets  to  saturate  them,  and  the  room  tightly  closed 
and  kept  so  for  twenty-four  hours  or  more,  after  which 
it  should  be  well  opened  and  aired,  to  rid  it  of  all  fumes. 
None  of  the  gaseous  disinfectants  can  be  depended 
upon  to  penetrate  thoroughly  into  large  and  thick  arti- 
cles such  as  mattresses.  Their  action  is  apt  to  be  super- 
ficial, and  it  is  therefore  important  that  the  articles  in  a 
room  to  be  disinfected  be  disposed  in  such  a  manner  as 
to  expose  as  much  surface  as  possible.  Bedding  should 
be  taken  out  of  piles  and  hung  on  ropes  or  racks,  pic- 


210       THE  PREVENTION   OF   EPIDEMICS 

tures  removed  from  walls,  books  opened  so  as  to  expose 
all  pages  if  possible,  pockets  turned  inside  out,  and  all 
boxes  opened. 

Formaldehyde  is  less  harmful  to  fabrics  and  colors 
than  the  other  gaseous  disinfectants,  and  is  altogether 
the  most  satisfactory  for  ordinary  use. 

Fluid  and  solid  chemicals,  the  latter  in  solution,  are 
much  used  as  germicides^  disinfectants^  or  antisej^tics. 
The  number  of  substances  so  used  is  large,  some  of  the 
more  important  of  them  being  the  various  acids,  per- 
manganate of  potash,  peroxide  of  hydrogen,  and  those 
to  be  discussed. 

Bichloride  of  mercury,  or  corrosive  sublimate,  is 
probably  the  most  important,  and  for  many  purposes 
the  most  valuable,  antiseptic  drug.  It  is  used  in  watery 
solution  of  various  strengths.  A  solution  as  weak  as 
one  part  in  one  million  has  some  value,  but  it  is  gener- 
ally used  in  strengths  varying  from  one  part  in  five  hun- 
dred to  one  in  five  thousand,  and  in  such  dilution  is  a 
very  powerful  antiseptic,  killing  most  germs  in  a  few 
minutes.  It  has  attained  popularity,  and  is  commonly 
sold  in  tablets  of  such  size  that  one  added  to  a  pint  of 
water  makes  a  one  to  one  thousand  solution.  The  main 
objections  to  bichloride  are  that  it  is  a  powerful  and 
deadly  poison,  and  the  tablets  in  which  it  is  sold  may, 
by  mistake,  be  taken  for  other  substances ;  and  that  it 
corrodes  and  injures  metals  with  which  it  may  come  in 
contact.  It  works  more  efficiently  when  combined  with 
an  acid,  and  the  tablets  are  usually  such  combinations. 

Carbolic  acid,  or  phenol,  is  quite  as  well,  if  not  better, 
known  as  an  antiseptic.  It  is  not  so  powerful  as  bichlo- 
ride, and  is  used  in  solution  of  from  one  to  five  per  cent 
strength.    Occasionally  it  is  used  in  what  is  called  its 


DEFENSES   AGAINST   DISEASE  211 

"  pure  "  form,  about  ninety-five  per  cent  strength.  It  is 
a  very  deadly  poison,  but  it  does  not  coiTode  metals  as 
does  bichloride,  and  is  therefore  better  for  disinfecting 
them.  Both  of  these  substances  irritate  and  injure  the 
hands  if  much  used. 

"  Trikresol "  is  a  disinfectant  that  is  supplied  and 
much  used  in  our  military  service.  It  is  less  readily  sol- 
uble than  phenol,  but  is  equally  as  powerful  a  disin- 
fectant when  used  in  half  the  strength  of  the  solution 
of  the  latter.   It  also  is  a  poison. 

Creolin  is  a  proprietary  coal-tar  preparation  issued 
by  the  Quartermaster's  Department  among  veterinary 
supplies.  It  makes  a  milky  suspension  in  water,  is  less 
poisonous  and  less  irritating  to  the  skin  than  carbolic, 
and  is  quite  as  potent  as  a  germicide. 

There  are  numerous  other  valuable  disinfectants  on 
the  market,  but  it  is  not  necessary  to  discuss  them,  as 
those  issued  to  the  service  answer  quite  as  well  as  any. 
It  should  be  stated,  however,  t\\a.t  formalin  is  also  used 
as  a  liquid  disinfectant,  and  for  some  purposes,  such 
as  the  disinfection  of  urine  and  feces,  it  is  probably  the 
most  valuable  one  we  have.  It  should  be  thoroughly 
mixed  with  a  stool  to  be  disinfected,  lumps  of  feces 
broken  up,  and  the  two  allowed  to  stand  in  contact  for 
a  time.    Formalin  is  also  a  valuable  deodorizer. 

For  a  few  diseases  we  have  remedies  that  may  be 

termed  specific,  or  truly  curative.    In  most  infectious 

diseases,  however,  we  are  only  able  to  mod-     ,  _    , 

•  .  IVIedi- 

ifv  the  course  of  the   affection,  to  relieve 

•         •  C1I16S 

symptoms  and  maintain  the  strength  and 
vitality  until  nature,  or  the  body  forces,  accomplishes  a 
cure  ;  and  even  the  specifics  cannot  always  be  given  in 
such  a  way  that  they  get  at  and  destroy  all  the  organisms 
of  disease. 


212       THE  PREVENTION   OF  EPIDEMICS 

Quinine  is  a  specific  for  malaria,  and  actually  de- 
stroys the  growing  and  multiplying  organisms  in  the 
blood.  Yet  men  occasionally  die  of  malaria  in  spite  of 
quinine,  and  many  hundreds  of  army  men  can  testify 
that  quinine  does  not  always  effect  a  prompt  and  per- 
manent cure  of  the  disease. 

3fercury  is  a  specific  for  syphilis.  It  kills  the  organ- 
isms causing  the  disease,  and  causes  the  lesions  to  heal; 
yet  the  men  who  have  devoted  the  most  attention  and 
study  to  the  subject  agree  that  treatment  must  be  con- 
tinued from  two  to  four  years  in  order  to  assure  a  cure. 

Antitoxin  is  a  specific  for  diphtheria,  neutralizing 
the  poison  and  making  it  harmless.  Yet,  if  it  be  not 
given  early  and  the  toxin  has  a  chance  to  unite  with  the 
tissues,  it  may  fail,  and  death  result  in  spite  of  its  use. 

Altogether,  the  consideration  of  specific  remedies 
cannot  but  convince  us  that  the  prevention  of  disease 
is  of  much  more  importance  and  value  than  its  treat- 
ment, and  that  the  tendency,  often  manifested,  to  regard 
the  medical  officer  as  one  whose  main  office  is  the  treat- 
ment of  men  already  sick,  one  who  should  have  nothing 
to  do  with  the  general  administration  of  a  post  or  an 
army,  is  a  very  grave  mistake.  Specifics  are  very  valu- 
able, however,  in  the  prevention  of  disease.  Mosquitoes 
are  not  apt  to  obtain  infection  from  the  blood  of  men 
taking  quinine,  nor  are  they  apt  to  convey  it  to  men 
who  are  so  doing.  The  man  who  is  taking  mercury  is 
less  apt  either  to  give  or  to  receive  syphilis  than  he  who 
is  not.  Prophylactic  injections  of  diphtheria  antitoxin 
offer  great  protection  to  persons  exposed  to  that  disease, 
and  the  amount  of  "  fourth  of  July  tetanus  "  has  been 
very  greatly  reduced  by  the  use  of  tetanus  antitoxin 
before  the  disease  shows. 


CHAPTER  XII 

TYPHOID    AND   OTHER   WATER-BORNE   DISEASES 

We  now  know  that  typhoid  fever  is  transmitted  in  a 
great  variety  of  ways,  and  there  is  reason  to  believe  that 
cholera,  dysentery,  "  camp  diarrhoea,"  and  parasitic  in- 
festations may  also  be.  This  entire  group  of  diseases 
has,  however,  so  long  been  spoken  of  as  water-borne, 
and  water  does  so  often  play  the  part  of  principal 
medium  in  their  transmission,  that  it  is  convenient  to 
discuss  them  under  this  head.  For  the  military  hygienist 
they  constitute  the  most  important  group  of  diseases, 
and  the  army  that  escapes  them  is  truly  fortunate.  In 
our  own  army  they  have  given  and  still  give  much  cause 
for  anxiety.  During  the  Civil  War  they  caused  more 
sickness  than  all  other  diseases,  and  so  lately  as  1898 
they  were  responsible  for  the  well-known  and  terrible 
conditions  prevailing  in  the  camps  of  concentration. 

Speaking  of  typhoid  fever  alone,  the  Board  on  the 
Origin  and  Spread  of  Typhoid  Fever  in  United  States 
Military  Camps  during  the  Spanish  War  of  1898  said  : 
"About  one  fifth  of  the  soldiers  in  the  national  en- 
campments in  the  United  States  in  1898  developed 
typhoid  fever.  Among  107,973  officers  and  men  in  92 
regiments,  the  records  of  which  we  have  carefully  stud- 
ied, the  number  of  cases  of  typhoid  fever,  according  to 
our  estimates,  was  20,738."  As  no  other  epidemic  on 
such  a  large  scale  has  been  studied  as  that  one  was ;  as 
the  lesson  is  drawn  from  our  own  service  and  the  facts 
are  more  or  less  familiar  to  officers  in  that  service  to- 


214       THE   PREVENTION   OF  EPIDEMICS 

day  ;  and  as  the  Board's  report  advanced  conclusions  of 
vast  importance,  frequent  reference  will  be  made  to  it 
in  this  chapter,  and,  to  save  time  and  space,  it  will  be 
spoken  of  as  the  Reed  Board,  because  Major  Walter 
Reed  of  the  Medical  Corps,  U.  S.  Army,  was  at  its  head. 
Furthermore,  typhoid  fever  will  be  the  subject  discussed 
in  nearly  all  of  this  chapter :  first,  because  it  is  always 
with  us,  in  spring,  summer,  fall,  and  winter,  in  Manila, 
Cuba,  home  stations,  or  Alaska  ;  and,  secondly,  because 
it  is  transmitted  in  so  many  ways  and  is  such  an  insid- 
ious enemy  that  absolute  protection  against  it  will  pro- 
bably insure  against  the  other  "  water-borne  "  diseases. 
The  exciting  causes  of  these  diseases  are  as  follows: 
Typhoid  fever  is  caused  by  a  bacillus  that  is  found  in 
-,  the  bowels,  gall-bladder,  blood,  and  internal 

organs  of  those  having  the  disease.  It  is 
an  actively  mobile  organism,  does  not  form  spores, 
is  easily  killed  by  heat,  and  does  not,  under  natural 
conditions,  produce  disease  in  other  animals  than  man. 
Cholera  is  caused  by  a  vibrio  or  spirillum,  a  spiral  bac- 
terium that  occurs  in  the  intestinal  discharges  and  con- 
tents of  persons  having  the  disease.  It  is  actively  mobile, 
multiplies  with  great  rapidity,  and  in  so  doing  the 
spirals  break  into  comma-shaped  fragments,  whence  the 
name  comma  hacUhis.  It  does  not  form  spores,  is  easily 
killed  by  heat  and  acids,  and  succumbs  to  the  action  of 
sunlight  more  promptly  than  most  other  organisms. 
Dysentery  is  a  name  applied  to  a  group  of  symptoms 
rather  than  to  one  specific  disease.  Consequently  it  is 
due  to  several  causes.  One  class  of  cases  is  caused  by 
a  group  of  closely  related  bacilli  that  present  some 
differences,  another  to  an  amoeba,  an  animal  parasite, 
and  still  others  to  other  microscopic  animal  parasites. 


WATER-BORNE   DISEASES  215 

Intestinal  infestations  with  worms  have  already  been 

discussed. 

Every  case  of  any  of  these  diseases  is  derived  from 

some  other  case.  We  may  at  times  have  great  difficulty 

in  tracinoj  the  origin  of  given  cases,  but  the     ^  .   . 

•  Ozisin 

more  we  learn  about  the  diseases  the  more  ^    . 

evident  the  truth  of  the  preceding  sentence      ,       .    " 

.  ucmics 

becomes.    Diet  and  unsanitary  conditions 

promote  the  spread  of,  but  cannot  originate,  typhoid. 
The  germs  must  be  introduced  by  man  and  are  so  in- 
troduced. The  man  who  first  brings  infection  to  a  camp 
may  have  the  fever  and  not  know  what  is  the  matter ; 
he  may  be  recovering  from  it  and  still  not  know,  or  he 
may  have  had  it  and  recovered  long  before,  but  be  a 
"carrier"  and  continue  excreting  bacilli  for  years. 
Some  of  the  conclusions  of  the  Reed  Board  are  as 
follows :  — 

"  (1.)  During  the  Spanish  War  of  1898  every  regi- 
ment constituting  the  First,  Second,  Third,  Fourth, 
Fifth,  and  Seventh  Army  Corps  developed  typhoid 
fever. 

"  (2.)  More  than  ninety  per  cent  of  the  volunteer 
regiments  developed  typhoid  fever  within  eight  weeks 
after  going  into  camp. 

"  (3.)  Typhoid  fever  developed  also  in  certain  regu- 
lar regiments  within  three  to  five  weeks  after  going  into 
camp. 

"  (4.)  Typhoid  fever  became  epidemic  both  in  the 
small  encampments  of  not  more  than  one  regiment  and 
in  the  larger  ones  consisting  of  one  or  more  corps. 

"(5.)  Typhoid  fever  became  epidemic  in  camps 
located  in  the  Northern  as  well  as  in  those  located  in 
the  Southern  States. 


216       THE   PREVENTION   OF  EPIDEMICS 

"  (6.)  Typhoid  fever  is  so  widely  distributed  in  this 
country  that  one  or  more  cases  are  likely  to  appear  in 
any  regiment  within  eight  weeks  after  assembly. 

"  (7.)  Typhoid  fever  usually  appears  in  military 
expeditions  within  eight  weeks  after  assembly." 

"  (43.)  In  addition  to  the  recognized  cases  of  typhoid 
fever,  there  were  many  short  or  abortive  attacks  of  this 
disease  which  were  generally  diagnosed  as  some  forms 
of  malarial  fever." 

The  above  conclusions  were  reached  before  there  was 
any  recognition  of  chronic  typhoidal  carriers,  and  the 
.  Board   knew   nothing   of   their   existence. 

Since  the  investigation  of  the  first  recog- 
nized chronic  carrier,  many  interesting  cases  have  been 
studied  and  their  histories  worked  out,  and,  as  they 
illustrate  the  dangers  from  this  source,  a  few  of  them 
will  be  detailed.  The  first  case  reported  was  that  of  the 
female  proprietor  of  a  bakery  in  Strassburg.  All  of  her 
employees  would  sooner  or  later  get  typhoid,  and  the 
cause  could  not  be  located.  It  was  at  length  ascertained 
that  the  woman,  who  had  had  typhoid  ten  years  pre- 
viously, was  still  passing  very  large  numbers  of  typhoid 
bacilli  in  her  stools.  In  a  British  reformatory  there  had 
been  intermittent  outbreaks  of  typhoid,  three,  four,  or 
five  cases  occurring  at  a  time.  Inquiry  pointed  to  milk 
as  the  cause,  but  inspection  of  the  dairy  and  its  sur- 
roundings showed  good  sanitary  conditions.  Neverthe- 
less the  disease  continued  to  appear.  Search  among 
those  handling  the  milk  in  the  institution  led  to  the 
examination  of  a  girl  who  had  had  typhoid  six  years 
previously.  Two  examinations  of  her  stools  were  nega- 
tive, but  the  third  showed  that  she  was  passing  typhoid 
bacilli.  Her  removal  from  the  kitchen  ended  the  epi- 
demics. 


WATER-BORNE   DISEASES  217 

The  first  instance  thoroughly  worked  up  in  America 
was  a  very  instructive  one.  The  investigation  began 
with  the  efforts  to  trace  a  small  epidemic,  six  persons 
in  a  household  of  eleven  being  attacked  with  the  disease. 
Thorough  investigation  at  the  time  of  this  outbreak  and 
for  some  time  subsequently  failed  to  disclose  the  source 
of  infection  in  the  food,  drink,  or  general  sanitary  con- 
ditions. At  length  suspicion  was  directed  to  a  cook  who 
had  worked  in  the  house  for  a  few  weeks,  beginning 
about  three  weeks  before  the  appearance  of  the  disease. 
With  great  difficulty  Dr.  George  A.  Soper  was  able  to 
trace  part  of  her  history  during  a  period  of  ten  years, 
in  which  she  was  known  to  have  lived  in  eight  families 
where  inquiries  could  be  made.  In  seven  of  these  she 
had  been  associated  with  typhoid  outbreaks,  always 
escaping  the  disease  herself.  In  the  seven  families  there, 
were  twenty-six  cases  of  typhoid,  with  one  death.  Owing 
to  the  cook's  refusal  to  tell  anything  about  herself,  and 
the  fragmentary  character  of  the  history  obtained,  it  is 
probable  that  she  had  been  associated  with  other  cases. 
On  the  information  obtained,  however,  the  New  York 
Department  of  Health  caused  her  removal  to  the  Deten- 
tion Hospital,  where  she  was  examined,  in  spite  of  her 
objections  and  resistance,  and  was  found  to  be  passing 
great  numbers  of  typhoid  germs  in  her  feces. 

Another  striking  case  is  reported  from  Prussia,  where 
typhoid  had  been  epidemic  on  a  large  estate  for  four- 
teen years.  During  that  time  there  had  been  thirty-two 
cases  of  the  disease  among  one  hundred  and  eighty 
persons  on  the  estate.  Investigations  focused  attention 
on  the  dairy,  all  of  the  persons  involved  having  used 
milk  from  it.  A  woman  employed  there  had  had  typhoid 
seventeen  years  before,  and  the  bacteria  were  found  in 


218       THE  PREVENTION  OF  EPIDEMICS 

her  stools  almost  to  the  exclusion  of  other  varieties. 
She  had  worked  in  the  dairy  fourteen  years,  and  had 
been  spreading  the  disease  during  that  time.  In  a 
recent  outbreak  in  Georgetown,  D.  C,  the  epidemic  was 
traced  to  milk  unknowingly  contaminated  by  a  woman 
who  had  had  the  disease  eighteen  years  before,  and  was 
still  passing  the  germs  in  her  stools. 

Such  instances  have  multiplied  of  late,  and  many 
more  could  be  cited,  but  enough  has  been  said  to  indi- 
cate the  very  great  importance  of  cleanliness  on  the 
part  of  cooks  and  other  persons  handling  foods,  and  the 
necessity  of  investigating  the  kitchen  in  the  case  of 
company  outbreaks.  It  is  also  worth  repeating  that 
good  men  should  be  detailed  on  kitchen  police,  and  re- 
warded for  efficient  and  cleanly  performance  of  the 
duty,  rather  than  that  poor  men  should  be  detailed  as 
a  punishment,  possibly  for  drunkenness,  uncleanliness, 
or  other  evidence  of  their  unfitness.  As  showing  that  the 
danger  from  "  carriers  "  is  not  slight,  it  may  be  stated 
that  of  386  cases  of  typhoid  occurring  in  one  sanitary 
district  in  Germany,  in  which  the  source  of  infection 
was  carefully  sought,  no  less  than  seventy-seven  could 
be  traced  to  them. 

Different  series  of  examinations  of  the  stools  of  per- 
sons who  have  had  typhoid  have  resulted  in  estimates 
varying  from  1.7  per  cent  to  5  per  cent  as  the  proportion 
of  such  who  continued  for  indefinite  periods  to  give  off 
bacilli.  One  case  of  twenty-nine  and  another  of  fifty- 
six  years'  duration  have  been  reported.  In  most  in- 
stances the  infection  lingers  in  the  gall-bladder,  and  it 
may  give  rise  to  the  formation  of  gall-stones.  In  addition 
to  the  above-described  class  of  chronic  carriers,  very 
many  more  cases  give  off   bacilli  in  the  stools  for  a 


WATER-BORNE   DISEASES  219 

short  time,  and  from  20  to  25  per  cent  pass  them  in 
urine  for  periods  varying  from  weeks  to  months  or,  in 
rare  cases,  years.  Rarely  there  are  found  carriers  who 
give  no  history  of  typhoid,  the  disease  apparently  having 
been  localized  in  the  gall-bladder  from  the  beginning. 

Carrier  cases  are  also  known  to  occur  from  cholera 
and  dysentery,  and  in  the  latter  instance  it  is  well 
known  that  the  organisms,  and,  in  fact,  the  disease 
itself,  may  be  present  for  years. 

The  Reed  Board  said  :  "  (48.)  When  a  command  is 
thoroughly  saturated  with  typhoid  fever,  it  is  probable 
that  one  fourth  to  one  third  of  the  men  will 
be  found  susceptible  to  this  disease."  It  is  '^ 

probable  that  the  susceptibility  to  cholera  ^ 

and  dysentery  among  American  troops  will  be  even 
higher,  as  they  have  not  had  such  opportunities  of 
acquiring  immunity  at  home  as  they  have  in  the  case 
of  typhoid. 

The  Reed  Board  reported :  "  (47.)  The  percentage  of 
deaths  among  cases  of  typhoid  fever  was  7.6^"   [a  low 
figure].  —  "  (54.)  The  deaths  from  typhoid 
fever  were  86.24^  of  the  total  deaths."  — 
"(56.)  The  mortality  from  typhoid  fever  per  1000  of 
mean  strength  was  14.63." 

Typhoid  fever  is  known  to  be  transmitted  in  all  of 

the  ways  to   be  considered,    and    it  must    ly-.     ,     , 

be  i^garded   as  possible  that  cholera  and 

dysentery  can  be  spread  in  most  or  all  of 

.{,  mission 

them. 

Water  was  not  found  by  the  Reed  Board  to  be  an 

important  factor  in  the  spread  of  typhoid 

in  the  national  encampments  in  1898  ;  but 

it  has  so  often  been  demonstrated  as  the  most  impor- 


220       THE   PREVENTION  OF   EPIDEMICS 

tant  factor  in  other  epidemics,  that  all  authorities 
agree  in  considering  it  one  of  the  first  subjects  to  be 
investigated  in  case  of  any  outbreak.  This  method  of 
transmission  is  so  well  recognized  and  so  generally 
known  that  it  is  not  necessary  to  cite  any  of  the  very 
numerous  instances  showing  it.  Prior  to  1898  practi- 
cally all  of  the  great  epidemics  that  had  been  studied 
were  traced  to  infected  drinking-supplies,  and  the  dis- 
ease was  regarded  as  mainly,  if  not  entirely,  water- 
borne.  This  fact  helps  to  account  for  the  size  and  extent 
of  the  great  camp  epidemics  of  that  year.  Cholera  and 
dysentery  have  also  usually  been  traced  to  infected 
water.  There  is,  however,  the  possibility  that  both  may 
be  transmitted  in  the  other  ways  to  be  considered. 

The  germs  may  be  ingested  directly  in  polluted  drink- 
ing water,  and  such  is  the  usual  method  in  large  epi- 
demics due  to  water.  The  danger  in  such  instances  of 
course  increases  with  the  dose  of  germs,  that  is,  with 
increase  in  the  degree  of  pollution  or  in  the  length  of 
time  the  water  is  used.  It  may  also  occur  in  less  obvious 
ways.  Thus,  water  that  is  used  in  clothes-washing  or 
bathing  may  become  infected  from  the  clothing  or  per- 
sons of  sick  men  or  carriers,  and  may  later  infect  the 
hands  or  persons  of  the  people  handling  or  using  it,  or 
the  vessels  in  which  it  was  contained.  Or  men  may  con- 
tract the  disease  by  bathing  or  swimming  in  infected 
streams  or  pools,  and  inadvei'tently  taking  water  into 
their  mouths,  noses,  or,  possibly,  their  eyes. 

Milk-borne  epidemics  of  typhoid  are  also  well  recog- 
nized, and  many  of  them  have  been  thoroughly  studied. 
The  milk  is,  in  the  great  majority  of  in- 
stances, contaminated  from  the  hands  of 
milkers,  dealers,  or  other  handlers  who  are  suffering 


WATER-BORNE   DISEASES  221 

from  beginning  typhoid  and  have  not  yet  ceased  work, 
who  are  convalescing  from  the  same  disease,  or  who 
have  had  it  formerly  and  are  still  "  carriers."  The  con- 
tamination may  occur  in  other  ways,  such  as  the  use  of 
infected  water  for  washing  cans  or  diluting  milk.  It 
may  also  linger  long  in  cans  once  infected,  if  they  are 
not  properly  washed  and  sterilized,  as  the  germs  will 
multiply  in  milk.  As  the  same  thing  is  true  of  the 
germs  of  cholera  and  dysentery,  they  may  also  be  milk- 
borne. 

One  of  the  latest  and  largest  milk-borne  epidemics 
of  typhoid  fever  occurred  in  the  suburbs  of  Boston  in 
the  spring  of  1908.  Four  hundred  and  ten  cases  oc- 
curred, the  infection  being  traced  to  a  milk-dealer  who 
continued  his  work  for  two  weeks  after  the  onset  of  the 
typhoid  fever  from  which  he  later  died. 

Lettuce,  radishes,  and  other  vegetables  or  fruits  that 
are  eaten  uncooked  may  be  contaminated  by  unclean 
handling,  by  washing  in  polluted  water,  by 
contact  with  typhoid  feces  or  urine  in  ma-  ° 

nure,  by  flies,  or  by  infected  dust  blown 
and  deposited  on  them.  Bread,  cool  meats, 
and  other  food-articles  may  also  be  con- 
taminated in  some  of  these  ways  after  they  are  cooked. 
Any  article  so  polluted  might  cause  the  disease  if  it 
were  eaten. 

Many  epidemics  of  typhoid  fever  liave  been  traced  to 
the  consumption  of  oysters  and  other  shellfish  gathered 
from  sewerage-infected  beds.  For  twenty- 
five  years  the  city  of  Belfast  had  had  the 
greatest  mortality  from  typhoid  of  all  the  cities  in  the 
United  Kingdom,  in  spite  of  a  good  water-supply  and 
good  general  sanitation.    A  commission  appointed  in 


222       THE   PREVENTION   OF   EPIDEMICS 

1907  to  investigate  the  matter  showed  that  the  endemic 
prevalence  of  the  disease  was  due  to  the  unrestricted 
gathering  of  cockles,  mussels,  and  other  shellfish  from 
the  "  slob-lands  "  of  Belfast  Lough,  which  are  laden 
with  the  city's  sewage.  Hundreds  of  acres  are  exposed 
at  low  tide,  and  the  shellfish  are  gathered  by  the  poorer 
classes,  who  generally  eat  them  raw.  The  Jews,  who  do 
not  eat  them,  were  exempt  from  the  disease.  It  is  prob- 
able that  cholera  and  dysentery  may  be  transmitted  in 
the  same  way. 

Living  and  virulent  typhoid  organisms  have  been 
found  in  the  mouths  of  persons  sick  with  the  disease, 
and  the  vomit  of  cholera  may  contain  the 
germs  of  that  ailment.  It  may  therefore  be 
understood  that  the  common  use  of  drink- 
'^  ing-cups,  clinical  thermometers,  and  other 

articles  that  are  put  to  the  mouth,  may  lead  to  infection. 
In  all  of  the  diseases  discussed  in  this  chapter  the  or- 
ganisms occur  in  the  intestines,  and  careless  use  of 
rectal  syringes  may  spread  them.  Such  an  accident  is, 
of  course,  more  apt  to  occur  in  hospitals. 

None  of  these  diseases  is  air-borne  in  the  sense  that 
smallpox  and  scarlet  fever  are,  but  feces,  urine,  or 
other  material  containing  the  causative  or- 
ganisms may  be  scattered  as  dust  when  well 
or  partially  dried  and  pulverized,  and  may  be  inhaled 
in  that  form,  or  may  light  on  articles  of  food  or  drink 
and  be  ingested  with  them.  The  Reed  Board  reported : 
"  (31.)  It  is  probable  that  the  infection  was  disseminated 
to  some  extent  through  the  air  in  the  form  of  dust." 

"  (28.)  Flies  undoubtedly  served  as  carriers  of  the 
infection.  Flies  swarmed  over  infected  fecal  matter  in 
the  pits,  and  then  visited  and  fed  upon  food  prepared 


WATER-BORNE   DISEASES  223 

for  the  soldiers  at  the  mess  tents.    In  some  instances 

where  lime  had  recently  been  sprinkled  over     __ 

•         •         •  Fli6s 

the  contents  of  the  pits,  flies  with  their  feet 

whitened  with  lime  were  seen  walking  over 
the  food.    It  is  possible  for  the  fly  to  carry     -- 
the  typhoid  bacillus  in  two  ways.    In  the 
first  place,  fecal  matter  containing  the  typhoid  germ 
may  adhere  to  the  fly  and  be  mechanically  transported. 
In  the  second  place,  it  is   possible  that  the  typhoid 
bacillus  may  be  carried  in  the  digestive  organs  of  the 
fly  and  be  deposited  with  its  excrement." 

So  far  as  known,  the  above  remarks  describe  equally 
well  the  relation  of  flies  to  cholera  and  dysentery  in- 
fections, and  infestations  with  intestinal  parasites.  The 
writer  has  seen  larval  roundworms  that  could  not  be  dif- 
ferentiated from  some  species  infesting  man,  in  the  pro- 
boscis of  a  fly.  So  far  as  known,  no  epidemics  have  been 
directly  traced  to  roaches,  yet  persons  familiar  with  these 
insects,  and  knowing  how  impartially  they  run  in  privies 
and  kitchens,  can  readily  see  how  they  might  spread 
disease,  especially  in  the  tropics.  Recently  the  Director 
of  Health  and  Chief  Quarantine  Officer  for  the  Philip- 
pine Islands  has  advanced  an  interesting  hypothesis  to 
account  for  the  persistence  of  cholera  in  iVIanila.  He 
says:  "The  cholera  organism  is  continuously  present  in 
some  form  in  the  sewer  system  of  Manila,  either  in  its 
fluid  contents  or  in  vermin.  ...  It  appears  probable 
that  the  cholera  organism  is  conveyed  either  directly  or 
indirectly  from  the  sewers  to  easily  contaminated  food 
or  drink  by  the  roaches,  either  through  direct  mechan- 
ical contact  with  their  feet  or  bodies,  or  by  the  deposi- 
tion of  their  excretions;  thence  it  is  passed  to  human 
beings ;  but  flies,  water-bugs,  and  other  vermin  com- 


224       THE   PREVENTION  OF  EPIDEMICS 

monly  found  in  sewers  are  also  no  doubt  partly  re- 
sponsible." 

It  would  be  well  for  the  line  officer  to  know  the 
following  facts  concerning  house-flies.  They  breed  in 
horse-manure,  human  feces,  and  other  filth,  and  can 
readily  emerge  through  six  inches  of  loose  earth,  but 
not  through  earth  saturated  with  water.  When  breeding 
in  feces  and  it  dries,  the  larvae  will  go  into  the  earth 
five  or  six  inches,  and  there  find  more  congenial  sur- 
roundings. They  are  naturally  most  numerous  about 
trench  latrines  and  kitchens,  because  they  find  in  those 
places  the  best  breeding  and  feeding  places  respect- 
ively. The  female  lays  about  120  eggs,  and  the  devel- 
opment of  these  varies  with  the  temperature,  somewhat 
as  follows :  — 

Hot  Weather    Cold  Weather 
Days  Days 

Ecfgs  hatch  in  12 

Maggots  change  to  pupae  in  5  14 

Pupae  change  to  adult  flies  in        3  5 

Total  Short      9      long  2 1   or  more 

Contact  with  sick  persons  offers  many  opportunities 
for  both  mediate  and  immediate  infection,  and  the  class 
of  diseases  under  discussion  often  infect 
nurses  and  attendants.  The  typhoid  patient, 
as  stated  before,  may  give  off  the  germs  of  the  disease 
from  his  bowels,  bladder,  or,  occasionally,  his  mouth. 
From  these  sources  the  bacilli  get  on  towels,  bedding, 
urinals,  chamber  pots,  the  patient's  skin,  and  into  bath 
water.  Any  of  these  articles  may  be  handled  by  nurses, 
associates,  or  casual  visitors,  who  may  thereby  infect 
their  own  hands  or  persons,  and  later  take  the  germs 


WATER-BORNE   DISEASES  225 

into  the  mouth.  Persons  using  the  same  drinking  glasses, 
linen,  or  other  jjersonal  articles,  as  the  sick  man,  are 
especially  apt  to  be  infected.  This  method  of  infection 
is  lately  receiving  much  more  recognition  than  formerly, 
and  it  is  now  prescribed  in  the  army  that  typhoid  fever 
cases  shall  be  isolated  and  treated  as  though  contagious. 
The  greatest  care  in  cleanliness  and  disinfection  is 
necessary  on  the  part  of  all  hospital  attendants  and 
others  brought  in  contact  with  the  disease.  The  danger 
is  of  course  greater  if  the  nature  of  the  disease  is  un- 
known, and  the  subject  pursues  his  ordinary  course  of 
life,  eating,  drinking,  sleeping,  defecating,  and  urinat- 
ing, with  no  thought  of  being  a  menace  to  others. 

Tent-mates  and  bed-mates  and  members  of  the  same 
family  and  household  are  particularly  exposed.  The 
Reed  Board  published  the  following  conclusions  that 
bear  on  the  subject :  "  (30.)  Typhoid  fever,  as  it  devel- 
oped in  the  regimental  organizations,  was  characterized 
by  a  series  of  company  epidemics,  each  one  having  more 
or  less  perfectly  its  own  individual  characteristics.  .  .  . 
Of  1608  cases  of  typhoid  fever  which  we  have  been 
able  to  accurately  locate  in  the  particular  tents  in  which 
they  occurred,  together  with  the  date  of  the  commence- 
ment of  the  attack,  the  results  may  be  summarized  as 
follows :  — 

"  Directly  connectable  attacks,  563,  or  35.01  per 
cent. 

"  Indirectly  connectable  attacks,  447,  or  27.79  per 
cent. 

"Total  connectable  attacks,  1010,  or  62.8  per  cent. 

.  .  .  "We  believe,  therefore,  that  personal  contact 
was  a  very  important  factor,  probably  the  most  im- 
portant, in  the  spread  of  the  disease." 


226       THE   PREVENTION   OF   EPIDEMICS 

It  will  be  readily  understood  that  the  dangers  of 
contact  would  be  greatly  increased  by  crowding,  poor 
ventilation,  and  uncleanly  habits. 

House  epidemics  of  cholera  are  common  in  the  Philip- 
pines during  epidemic  seasons,  and  owe  their  origin  and 
spread  to  the  causes  discussed  above,  to  the  common 
use  of  food  and  drinking  utensils,  and  to  infection  con- 
tracted in  cleaning  up  vomit  and  watery  stools.  There 
is  good  reason  to  think  that  dysentery  and  diarrhoea 
may  be  spread  in  the  same  ways,  while  it  is  well  known 
that  intestinal  worms  often  are,  among  children. 

The  above  discussion  of  the  dangers  of  contact  with 
sick  persons  may  be  applied  equally  well  to  similar  re- 
lations with  carriers,  except  that  they  are  not  known 
to  be  sources  of  danger,  and  are  thereby  rendered 
more  harmful.  They  are  more  apt  than  sick  men  to 
sleep  with  other  persons,  to  lend  or  borrow  clothing,  to 
be  put  on  duty  in  kitchens,  or  handling  foods,  or  caring 
for  cows,  while  no  precautions  are  taken  in  the  matters 
of  disinfecting  their  clothing,  stools,  or  urine. 

It  does  not  require  lengthy  argument  to  demonstrate 
that,  if  urine  and  feces  contain  disease-producing  germs 
—    .^   J  and  are    deposited  on   the  surface  of  the 

_  ground  about  camps  or  are  allowed  to  soil 

the  edges  and  vicinity  of  latrines,  men  may 
get  their  shoes  soiled  with  such  matters  and  the  con- 
tained germs.  Such  being  the  case,  the  contamination 
might  easily  be  conveyed  to  tents,  bunks,  company 
streets,  and  the  hands  of  the  men.  Needless  to  say,  such 
infection  could  be  conveyed  even  though  all  gross  evi- 
dence of  fecal  or  urinary  soiling  were  removed. 

This  term  includes  such  inanimate  articles  or  sub- 
stances as  are  thought  capable  of  absorbing,  preserving. 


WATER-BORNE   DISEASES  227 

and  transmitting  the  contagii  of  disease,  and  is  used 
as  a  general  designation  for  such  tilings  as  books, 
clothing,  tents,  bedding,  and  baggage.  The  pQ^^i^es 
Reed  Board  reached  the  following  conclu- 
sions bearing  on  the  subject :  "  (32.)  A  command 
badly  infected  with  typhoid  fever  does  not  lose  the  in- 
fection by  simply  changing  location.  (33.)  When  a 
command  badly  infected  with  typhoid  fever  changes  its 
location,  it  carries  the  specific  agent  of  the  disease  in 
the  bodies  of  the  men,  in  their  clothing,  bedding,  and 
tentage.  (34.)  Even  an  ocean  voyage  does  not  relieve 
an  infected  command  of  its  infection.  (35.)  After  a 
command  becomes  badly  infected  with  typhoid  fever, 
changes  of  location,  together  with  thorough  disinfection 
of  all  clothing,  bedding,  and  tentage,  is  necessary.  .  .  . 

"  That  the  floors,  furniture,  and  bedding  of  barracks 
may  become  infected  with  typhoid  fever  and  may  con- 
tinue to  endanger  the  life  and  health  of  its  occupants 
for  a  long  time  is  abundantly  shown  in  the  records  of 
military  surgeons.   .  .  . 

"  Our  investigations  certainly  demonstrate  that  ty- 
phoid fever  is  not  only  an  infectious  but  also  a  conta- 
gious disease  ;  that  it  may  be  transferred  from  one 
person  to  another  by  contact,  and  that  the  clothing, 
bedding,  and  rooms  of  typhoid  patients  should  be  dis- 
infected with  as  much  care  as  is  now  given  to  these 
matters  in  cases  of  diphtheria  and  scarlet  fever." 

Clothing  that  is  grossly  contaminated,  such  as 
sheets  or  shirts  soiled  by  the  diarrhoeal  discharges  of 
sick  men,  is,  of  course,  most  dangerous,  but  the  danger 
in  such  cases  is  apt  to  be  recognized  and  provision 
made  for  it.  On  the  other  hand,  bedding  soiled  by 
dirty  shoes,  tents  that  have  been  urinated  upon,  the 


228       THE   PREVENTION  OF  EPIDEMICS 

clothing  of  apparently  well  carriers,  and  other  articles, 
may  be  infected  and  show  no  signs  of  it,  and  so  cause 
great  harm.  Laundry- workers,  hospital  attendants,  and 
tent-mates  of  the  sick  are  naturally  more  liable  than 
others  to  infection  in  this  way ;  yet  all  may  be  exjjosed 
to  it  in  time  of  epidemics. 

The  general  measures  for  the  prevention  of  these 
diseases  ai'e  those  hygienic  precautions  that  have  been 
__  discussed  in  preceding  chapters.  If  cases  do 

begin  to  appear  in  a  command,  it  is  evident 
that  they  have  not  been  sufficient,  and  more 
vigorous  steps   should  be  taken  to  protect 
the  men  not  yet  infected.  If  they  show  in  the  neighbor- 
hood of  the  command,  or  along  lines  of  communication 
with  it,  the  same  active  measures  shoidd  be  adopted. 
The  best  prospects  for  the  prevention  or  control  of  the 
epidemic  will  be  offered  if  the  following  steps  be  taken. 
One  of  the  most  important  of  these  is  early  diagnosis 
of  the  dangerous  cases.    As  long  as  their  nature  is  un- 
known,  they  continue   to  disseminate  the 
^  disease-germs;    and    such   undiagnosed   or 

.  °  "  wrongly  diagnosed  cases  apparently  had 
much  to  do  with  the  spread  of  typhoid  fever 
in  the  camps  in  1898.  At  that  time  the  methods  of 
diagnosis  were  not  so  good  as  at  present,  and  a  positive 
diagnosis  of  typhoid  could  not  usually  be  made  until 
after  the  patient  had  been  sick  a  week  or  more. 
Laboratory  methods  now  permit  of  it  sooner,  but  they 
are  not  always  available,  and  the  safe  rule  is  to  regard 
and  handle  suspected  cases  as  though  the  disease  were 
known  to  be  typhoid. 

The  diagnosis  is  a  matter  for  the  medical  officer  to 
worry  over,  but  the  line  officer  can  be  of  assistance  if 


WATER-BORNE   DISEASES  229 

he  instructs  his  men  to  go  on  sick  report  if  they  are  not 
well,  and  if  he  does  not  unduly  encourage  the  notion 
that  men  only  seek  sick  report  to  escape  work.  It  is 
at  any  rate  better  that  two  or  three  frauds  should  be 
allowed  to  loaf  for  a  time  than  that  one  sick  man  should 
be  allowed  to  spread  disease  through  the  command. 
The  Reed  Board  made  the  following  findings  that  bear 
on  the  difficulties  and  importance  of  early  diagnosis:  — 

"  (46.)  Army  surgeons  correctly  diagnosed  about  half 
the  cases  of  typhoid  fever." 

"  (14.)  A  man  infected  with  typhoid  fever  may  scatter 
the  infection  in  every  latrine  in  a  regiment  before  the 
disease  is  recognized  in  himself." 

Diagnosis  is  of  no  value  in  the  prevention  of  epi- 
demics unless  it  leads  to  immediate  steps  to  prevent 
infection  through  contact,  soil-pollution, 
water-pollution,  and  in  other  ways.  It 
should  therefore  lead  to  the  isolation  of  all  recognized 
or  suspected  cases,  and  such  measures  of  care  as  will 
prevent  their  spreading  the  disease  in  any  of  the  ways 
discussed  in  this  chapter.  Such  measures  must  include 
screening  from  flies,  disinfection  of  clothing  and  linen, 
sterilization  of  bath  water,  dishes  and  utensils,  disinfec- 
tion of  stools,  urine,  and  spit.  Only  the  necessary  at- 
tendants, and  they  well-trained  ones,  should  have  access 
to  the  patients.  The  isolation  should  at  times  include 
suspects  who  have  been  exposed  to  disease  as  well  as  the 
actually  sick.  This  is  particularly  true  as  regards  chol- 
era. It  is  necessary  in  a  less  degree  for  typhoid,  and 
still  less  for  dysentery.  Whenever  resorted  to,  such 
isolation  should  more  than  cover  the  ordinary  period  of 
incubation  of  the  disease.  Cholera  suspects  should  be 
isolated  for  five  days,  those  of  typhoid  for  three  weeks 


230       THE  PREVENTION  OF  EPIDEMICS 

or  until  well.  In  the  latter  disease  such  strict  isolation 
may  not  be  necessary,  but  in  case  of  severe  epidemics 
it  will  be  wise,  and  can  be  done  in  isolation  camps,  where 
the  men  can  work,  drill,  and  play.  At  times  it  may  be 
advisable  to  quarantine  entire  organizations  as  suspects, 
or  to  direct  the  measure  against  towns  or  communities. 
Isolation  cannot  be  made  an  effective  measure  of 
disease-prevention  unless  it  includes  all  cases  of  the 

disease  in  question,  and,  in  many  instances, 

^         all  suspected  cases.  It  is,  therefore,  essen- 

^ .  tial  that  all  cases  and  suspects  be  promptly 

c  r*  reported  to  the  central  authority,  in  order 

that  proper  steps  may  be  taken.  It  is  only 
rarely  that  difficulty  will  arise  in  this  matter  as  it  re- 
gards the  military  personnel ;  but  cases  among  civilians 
and  residents  of  the  locality  in  which  the  troops  are 
quartered  may  be  willfully  concealed.  Epidemics  "  hurt 
business,"  and  often  interfere  with  transportation  and 
traffic,  and  for  this  reason  and  others  it  is  not  uncom- 
mon that  great  efforts  are  made  to  hide  or  deny  their 
existence. 

It  therefore  occasionally  becomes  necessary  to  make 
regular  and  frequent  inspections  and  examinations  of 

all  persons  in  camp,  and  less  frequently  of 

those  in  the  neighborhood.    If  the  commu- 
^     '       nity  is  under  military  control,  this  may  be 

a  relatively  simple  matter,  but  where  such  is 
not  the  case  it  may  be  one  of  extreme  difficulty,  and  call 
for  the  display  of  much  forbearance,  good  temper,  and 
tact.  When  such  measures  are  necessary,  they  should  be 
under  the  charge  and  direction  of  medical  officers  who 
will  see  that  they  thoroughly  accomplish  their  purpose, 
but  at  minimum  of  inconvenience,  and  that  they  are 


WATER-BORNE   DISEASES  231 

conducted  in  such  a  manner  as  to  gain  rather  than  alien- 
ate the  sympathy  and  the  cooperation  of  the  civil  pop- 
ulation and  its  medical  practitioners.  If  many  sick 
are  found  it  may  be  necessary,  in  order  to  control  the 
epidemic,  to  establish  large  isolation  camps  and  special 
hospitals  for  civilians.  The  gathering  of  large  crowds 
from  many  places,  as  in  pilgrimages,  fairs,  and  religious 
festivals,  should  be  particularly  forbidden  during  chol- 
era epidemics.  Health-inspections  may  also  be  made 
the  means  of  much  sanitary  instruction,  and  may  thus 
do  great  good  in  addition  to  that  accruing  from  a  know- 
ledge of  the  location  of  cases.  Such  inspection,  exami- 
nations, and  instructions  have  been  resorted  to  in  times 
of  cholera  epidemics,  and  among  peoples  living  under 
military  control,  with  great  success.  They  redound  to 
the  benefit  of  the  civil  as  well  as  the  military  population. 
Inspections  of  troops  for  the  presence  of  disease  are  not 
infrequently  resorted  to,  and  often  do  much  good. 

Every  case  of  any  of  these  diseases  that  is  reported 
or  discovered  should  be  investigated  as  thoroughly  as 
possible  as  to  its  origin.  This  investigation 
may  show  no  results  in   single  cases,  but 
when  the  finding's  in  many  cases  are  com-    °^ 

C3.S6S 

pared  they  may  give  important  information 
as  to  the  cause  of  the  epidemic.  Thus  it  may  be  found 
that  it  is  confined  to  persons  using  a  certain  water,  to 
those  consuming  milk  sold  by  a  special  dealer,  or  who 
eat  the  productions  of  a  certain  cook,  or  who  have  par- 
taken of  shellfish ;  or  that  the  cases  are  otherwise  con- 
nected in  some  way.  The  information  thus  gained  may 
direct  attention  to  the  cause  of  an  epidemic,  and  its 
removal  may  put  an  end  to  the  whole  matter.  The  tra- 
cing of  epidemics  is,  however,  often  a  difficult  matter, 


232       THE  PREVENTION  OF  EPIDEMICS 

and  the  detection  of  typhoid-carriers  is  particularly  so. 
If,  for  instance,  a  carrier  were  put  on  kitchen  police  for 
a  day  and  infected  the  food  of  a  company,  a  dozen  men 
might  contract  the  disease  as  a  result.  They  might  de- 
velop it,  however,  in  from  one  to  three  weeks,  or  possibly 
more,  and  meanwhile  a  large  number  of  men  may  have 
worked  in  the  kitchen,  and  many  other  factors  having 
an  appai'ent  bearing  may  have  come  to  light,  so  that  all 
thought  is  diverted  from  the  man  really  causing  the 
trouble. 

In  very  many  instances  the  cause  of  the  epidemic  can- 
not be  ascertained,  or  at  least  not  soon  enough  to  permit 
its  removal  in  time  to  prevent  numerous  infections,  and 
protection  must  be  sought  in  the  practice  of  such  general 
preventive  measures  as  are  applicable.  These  should  take 
into  consideration  the  various  methods  in  which  the  dis- 
eases are  transmitted,  and  will  embrace  the  following. 
Cleanliness  of  persons,  tents,  kitchens,  and  camps  is 
of  paramount  importance,  and  officers  should  encourage 
it  by  precept,  example,  orders,  and,  if  neces- 
sary,  punishment.  Those  associated  with 
the  sick  should  be  particularly  careful  as  to 
their  persons,  surroundings,  and  food.  They  should  keep 
clean  tents,  wash  themselves  frequently,  disinfect  their 
hands  after  handling  the  sick,  their  bedding,  clothing, 
or  other  personal  belongings,  should  be  careful  not  to 
use  the  same  drinking  or  eating  utensils,  and  in  other 
ways  should  avoid  the  dangers  of  contact.  Disinfection 
of  clothing,  bedding,  tents,  rooms,  barracks,  urinals,  la- 
trines, and  all  the  things  used  by  the  sick  man,  should 
follow  his  removal  from  the  barracks,  tent,  camp,  or 
temporary  hospital.  Articles  that  cannot  be  well  dis- 
infected, such  as  hats  and  leather  gloves,  should  be 


WATER-BORNE   DISEASES  233 

destroyed  if  probably  infected.  Latrines  that  are  in- 
fected should  be  disinfected  as  well  as  possible,  and  if 
pits  or  other  cheap  arrangements,  closed.  General  good 
hygiene  should  prevail.  Sunshine  and  fresh  air  should 
be  provided  in  abundance  to  destroy  and  dilute  the 
poison ;  temperance,  order  and  regularity  of  habits  en- 
couraged, overwork  and  idleness  alike  avoided,  and 
cheerful  and  rational  living  enjoyed.  The  ground 
should  be  kept  so  clean  as  to  leave  no  opportunity  for 
fecal  or  urinary  contamination  of  shoes,  no  breeding- 
places  or  food-supplies  for  flies  or  roaches,  and  no  in- 
fected dust  to  blow  about.  The  effect  of  not  doing  these 
things  is  seen  more  promptly  in  cholera  than  in  typhoid, 
because  the  incubation  period  in  the  former  is  shorter 
and  effects  become  manifested  before  causes  are  forgot- 
ten.  In  that  instance,  lack  of  sunshine,  intemperance 
in  food  and  drink,  fear,  and  unhygienic  surroundings 
are  regarded  as  important  predisposing  causes  of  the  dis- 
ease. Increased  care  and  attention  should  be  gfiven  to 
the  disposal  of  feces,  urine,  vomit,  and  other  wastes, 
and  to  the  elimination  of  flies  and  other  insects  and 
protection  from  them.  Cremation  of  waste  materials 
should  be  resorted  to  if  practicable.  Reed  troughs,  safe 
water-carriage,  or,  better  still,  incinerators,  should  be 
used  to  dispose  of  feces  and  urine.  Men  should  be  in- 
structed to  use  only  the  latrines  and  urinals  of  their 
own  companies  so  far  as  it  is  possible  to  do  so,  and 
under  no  circumstances  to  urinate  or  defecate  on  the 
ground.  The  Reed  Board  reported  :  "  (15.)  Camp  pol- 
lution was  the  greatest  sin  committed  by  the  troops  in 
1898." 

Cleanliness  of  camp-sites  and  good  general  police  are 
therefore  of  very  great  importance,  both  as  preventing 


234       THE   PREVENTION   OF   EPIDEMICS 

accumulations  of  infective  material  and  as  keeping 
down  flies  and  other  vermin.  The  Reed  Board  pub- 
lished two  important  and  pertinent  conclusions  bearing 
on  this:  — 

"  (36.)  Except  in  case  of  the  most  urgent  military 
necessity,  one  command  should  not  be  located  upon  the 
site  recently  vacated  by  another. 

"  (37.)  The  fact  that  a  command  expects  to  change 
its  location  does  not  justify  neglect  of  the  proper  po- 
licing of  the  ground  occupied.  ...  A  camp-site 
should  be  thoroughly  policed  up  to  the  moment  of 
vacating  it.  This  should  be  insisted  upon  as  a  matter 
of  military  discipline,  and  camp  commanders  should 
regard  proper  attention  to  the  sanitation  of  the  site 
occupied  by  their  troops  as  one  of  their  highest  duties, 
and  its  neglect  as  a  crime." 

"  (21.)  Greater  authority  should  be  given  medical 

officers  in  questions  relating  to  the  hygiene  of  camps." 

Recent  experiments   show   that  typhoid  bacilli  can 

live  and  retain  their  virulence  in  soil  for  several  weeks 

or  months. 

When,  because  of  want  of  foresight,  neglect,  or  for 
any  other  reason,  a  command  is  located  on  a  polluted 
site,  a  change  may  be  desirable.    As  stated 
-  g,.  before,  this  cannot  be  depended  upon  to 

rid  the  command  of  infection  and  disinfec- 
tion :  isolation  and  the  other  measures  herein  advocated 
must  continue  to  be  used,  but  the  change  may  at  any 
rate  reduce  the  intensity  of  the  virus  and  the  number 
of  channels  of  infection.  The  dust  blown  about  camp 
would  be  less  dangerous,  the  number  of  flies  smaller, 
and  the  opportunities  for  fecal  contaminations  fewer,  in 
the  new  camp.  The  Reed  Board  considered  the  failure 


WATER-BORNE   DISEASES  235 

to  change  from  polluted  or  bad  sites  a  factor  in  the 
spread  of  the  epidemics  in  1898. 

"  (16.)  Some  commands  were  unwisely  located. 

"  (17.)  In  some  instances  the  space  allotted  the  regi- 
ments was  inadequate. 

"(18.)  Many  commands  were  allowed  to  remain  on 
one  site  too  long. 

"  (19.)  Requests  for  change  in  location  made  by 
medical  officers  were  not  always  granted." 

"  (39.)  In  some  of  the  encampments  the  tents  were 
too  much  crowded.  The  danger  of  camp-pollution 
would  naturally  be  increased  by  crowding." 

The  water  used  for  drinking,  dishwashing,  and  sim- 
ilar purposes  can,  of  course,  be  sterilized  by  boiling ;  but 
as  many  men  seek  other  water  to  drink,  it  is 
desirable  that  only  a  pure  supply  be  avail- 
able,  and  if  one  purified  by  large  filtration  ^'^  ^ 

plants  or  other  means  is  to  be  obtained,  it  should  be. 
At  times  it  may  be  necessary  to  take  steps  to  guard  the 
purity  of  a  supply  known  to  be  good.  Reservoirs,  fil- 
ters, or  watersheds  may  need  to  be  patrolled  to  prevent 
their  contamination.  Bathing  in  drinking-supplies 
should  of  course  be  prevented.  The  rule  to  be  always 
followed  in  time  of  epidemics  is,  however,  to  drink  no 
water  not  purified  by  heat.  No  matter  how  good  a 
general  supply  is  to-day,  the  possibilities  of  infection 
are  so  numerous,  and  so  hard  to  guard  against,  that 
certainty  as  to  the  purity  of  to-morrow's  supply  cannot 
be  entertained. 

Ice,  unless  made  from  distilled  water  and  handled 
with  all  possible  care,  should  not  be  allowed  to  come 
in  contact  with  articles  of  food  or  drink  during  the 
prevalence  of  epidemics.    It  may  contain  germs  frozen 


23G        THE   PREVENTION    OF   EPIDEMICS 

in  it,  or  tliey  may  liave  been  deposited  on  the  surface 
by  improper  handling. 

The  safest  rule  as  to  foods  is  the  same  as  that  just 
applied  to  water,  — to  take  none  that  is  not  sterilized. 
This  rule  is  pretty  generally  applied  by 
Americans  in  the  Philippines,  especially 
^  during  cholera  epidemics,  but  it  has  not 
had  such  general  application  in  our  own  country  or  as 
a  measure  of  defense  against  typhoid.  Heat  is  the 
means  of  sterilization  for  most  foods,  and  cooking  the 
method  of  applying  it.  However,  such  articles  as  ba- 
nanas, mangoes,  apples,  cucumbers,  melons,  that  are 
protected  by  a  thick  skin  or  rind,  may  be  washed  in 
bichloride  or  other  antiseptic  solution,  and,  later,  peeled. 
The  use  of  pies,  soft  drinks,  milk,  and  similar  articles 
sold  by  peddlers,  is  in  general  to  be  deprecated,  and  it 
may  be  advisable  to  stop  such  sales.  Green  vegetables 
may  also  have  to  be  banned,  particularly  in  cholera  times 
and  where  dysentery  and  the  practice  of  manuring  with 
human  feces  coexist.  If  either  typhoid  or  cholera  ap- 
})ears  in  the  person  or  family  of  a  dealer  in  food-stuff 
or  milk,  his  business  should  be  stopped  at  once,  or 
allowed  to  continue  only  under  such  rigid  rules  as  will 
destroy  all  chance  of  dissemination  of  the  infection.  If 
the  person  cannot  be  controlled  by  military  authority, 
the  soldiers  should  be  forbidden  to  deal  with  him. 

Typhoid,  cholera,  and  dysentery  are  all  diseases  in 

which  more  or  less  protective  value  has  been  attributed 

.  to  vaccination.    The  degree  of  protection 

ao^ainst  cholera  that  is  afforded  by  this 
tion  .  .  . 

measure  is  considerable,  and  its  very  ex- 
tensive use  in  India,  Japan,  and  other  countries  has 
given  results  tliat  assure  it  a  prominent  place  in  the 


WATER-BORNE  DISEASES  237 

suppression  of  epidemics.  The  methods  of  so-called 
vaccination  vary  considerably,  but  all  have  the  common 
feature  that  the  germ-substance,  either  living,  dead,  or 
extracted,  is  injected  beneath  the  skin.  This  gives  rise 
to  varying  degrees  of  local  reaction,  and  some  fever  and 
discomfort  that  lasts  from  a  few  hours  to  a  few  days, 
but  it  results  in  the  formation  in  the  blood  of  anti- 
bacterial and  immunizing  substances  that  in  most  in- 
stances fully  protect  against  the  disease.  Anti-typhoid 
inoculation  or  vaccination  has  had  a  less  extensive  use, 
and  such  as  it  has  had  has  been  almost  entii-ely  in  the 
British  army.  The  results  there,  however,  have  been 
sufficiently  favorable  to  cause  an  extension  of  the  prac- 
tice, so  that  it  is  now  very  generally  used.  The  accounts 
thus  far  published  indicate  that  the  method  is  of  great 
value,  and  that  it  may  yet  come  to  be  the  practice  in 
our  own  country  to  vaccinate  new  troops  before  sending 
them  on  campaign  or  to  great  camps  of  concentration. 
The  method  at  present  in  use  consists  in  the  injection  of 
a' large  number —  1,000,000,000  to  2,000,000,000  — of 
germs  that  have  been  killed  by  exposure  to  a  temperature 
not  in  excess  of  60°  C.  This,  as  in  the  case  of  cholera, 
results  in  the  formation  in  the  body  of  anti-bacterial  and 
immunizing  substances  ;  but  if  the  injection  is  made 
during  the  incubation  period  of  the  disease,  or  if  infec- 
tion takes  place  very  soon  after,  the  fever  is  both  more 
certain  and  more  severe  in  its  development.' 

1  S.  O.  279,  Dec.  1,  1908,  War  Dept. 
(Extract.) 
12.  A  board  of  medical  officers  to  consist  of  Briij.  Gen.  Robert  M. 
O'Reilly,  Surg-.  Gen. ;  1st  Lieut.  Victor  C.  Vauphan,  ^i.  R.  C. ;  1st  Lieut. 
William  T.  Councilman.  M.  R.  C. ;  1st.  Lieut.  John  II.  Musser,  M.  R.  C. ; 
1st  Lieut.  Alexander  Lambert,  M.  R.  C. ;  1st  Lieut.  Simon  Flexner, 
M.  R.  C. ;  1st  Lieut.  William  S.  Thayer,  M.  R.  C. ;  Capt.  Frederick  F. 


238       THE  PREVENTION   OF   EPIDEMICS 

Anti-dysenteric  vaccination  has  been  said  to  be  of 
value,  but  it  has  thus  far  not  had  sufficient  trial,  or 
given  sufficiently  satisfactory  results  to  make  its  use 
advisable. 

Russell,  M.  C.,  recorder,  is  appointed  to  meet  in  Washington  on  Dec.  7, 
1908,  for  the  purpose  of  investigating-  the  question  of  the  advisability 
of  immunizing  the  Regular  and,  in  case  of  war,  the  Volunteer  Army 
against  typhoid  fever. 

The  board  met  at  2  p.  m.,  all  the  members  being  present.  It  proceeded 
to  review  the  history  of  vaccination  as  a  method  of  protecting  troops 
against  typhoid  fever.  The  experience  of  both  the  Engiisli  and  the 
German  armies  was  considered. 

The  theory  on  which  the  practice  is  based  as  well  as  many  details 
involved  in  carrying  out  the  procedure  were  considered,  as  was  also 
the  probable  effect  on  the  medical  profession  and  the  public  at  large  in 
the  United  States. 

As  a  result  of  several  hours'  discussion  the  board  adopted,  without 
any  dissenting  voices,  the  following  conclusions  :  — 

I.  The  board  is  convinced  that  the  practice  of  anti-typhoid  vaccina- 
tion is  both  useful  and  harmless,  and  that  it  offers  a  practicable  means 
of  diminishing  the  amount  of  typhoid  fever  in  the  Army,  both  in  times 
of  peace  and  war. 

II.  It  finds  that  the  experience  to  date  with  anti-typhoid  vaccination 
justifies  it  in  recommending  the  introduction  of  the  practice  in  the 
Regular  and  Volunteer  Armies  in  time  of  war. 

III.  It  recommends  the  immediate  introduction  of  the  practice  of 
voluntary  vaccination  against  typhoid  in  the  Hospital  Corps,  the  Army 
Nurse  Corps,  and  in  any  expedition  of  troops  from  the  Regular  Army 
which  is  ordered  to  take  the  field  for  active  operations  ;  and,  further, 
that  an  opportunity  be  given  to  Volunteers  from  the  Army  as  a  whole 
to  be  protected  by  vaccinations  against  typhoid. 

There  being  no  further  business  before  it,  the  board  adjourned  sine 
die. 

R.  M.  O'Reilly,  Surgeon-General,  U.  S.  A.,  President. 


CHAPTER  XIII 

AIR-BORNE   AND   FOMITES-BORNE   DISEASES 

The  terms  "air-borne"  and  "  f  omites-borne  "  do  not 
tell  the  whole  story  of  the  methods  of  transmission  of 
the  diseases  here  to  be  considered,  just  as 
"  water-borne  "  failed  to  tell  it  of  those  dis- 
cussed in  the  preceding  chapter.    Most  of     ^. 
those  now  to  be  treated  of  are  also  known 
as  contagious  diseases,  though  the   term  is  elastic  and 
may  be  used  in  different  senses.    As  ordinarily  applied 
to  those  diseases,  it  is  understood  to  mean  that  the  sub- 
ject of  one  of  them  is  surrounded  by  a  zone  of  atmos- 
phere in  which  the  poison  or  contagium  is  present  and 
which  may  convey  the  disease  to  persons  entering  it. 

The  principal  diseases  in  this  group  are  measles, 
scarlet  fever,  German  measles,  smallpox,  chicken-pox, 
influenza  or  grippe,  mumps,  whooping-cough,  and  diph- 
theria. Many  other  diseases  may  be  borne  by  fomites 
and  by  dust-laden  air,  among  them  tuberculosis,  typhoid 
and  cholera,  tonsillitis,  and  possibly  pneumonia  and 
meningitis  ;  but  the  bulk  of  this  chapter  will  be  devoted 
to  the  contagious  group,  especially  measles,  scarlet  fever, 
and  smallpox. 

Some  of  the  diseases  mentioned  above  —  influenza, 
tuberculosis,    diphtheria,    meningitis,    and     ^ 
tonsillitis  —  are  known  to  be  caused  by  bac-  _ 

teria,  and  the  organisms  can    be    isolated 
and  identified.    Smallpox  is  probably  due     ° 
to  a  minute  animal  parasite,  but  the  relationship  is  not 


240       THE  PREVENTION   OF  EPIDEMICS 

generally  acknowledged.  The  causes  of  measles,  German 
measles,  scarlet  fever,  and  whooping-cough  are  still 
unknown,  and  it  is  possible,  though  not  certain,  that 
some  of  them  are  due  to  organisms  too  small  to  be  seen 
by  the  microscope.  On  the  other  hand,  different  inves- 
tigators have  at  various  times  described  what  they 
thought  to  be  the  causative  organisms.  The  chances  are 
rather  against  great  advances  being  made  in  the  man- 
agement of  these  diseases  until  their  causes  are  known, 
though  such  is  not  necessarily  the  case.  Vaccination 
was  found  to  be  preventive  of  both  smallpox  and  hydro- 
phobia, though  the  causative  organisms  were  unknown  ; 
yellow  fever  has  been  brought  under  control  despite  the 
fact  that  we  do  not  know  its  cause,  and  typhus  has  been 
all  but  exterminated  and  we  are  still  ignorant  as  to 
what  produces  it.  Nevertheless,  vaccination,  mosquito 
destruction,  and  good  general  hygienic  measures  have 
failed  to  do  away  with  measles,  scarlet  fever,  and  in- 
fluenza. 

Certain  factors  have  an  important  influence  in  pre- 
disposing to  some  of  these  diseases,  and  enable  us  to 
_     J.  exercise  some  measure  of  control  over  them. 

Most  of  them  are  so  prevalent  in  the  very 
'posins  , 

-,  young  as  to  be  known  as  "  the  diseases  of 

childhood."  By  this  phrase  we  usually  speak 
of  the  group  including  mumps,  measles,  scarlet  fever, 
German  measles,  chicken-pox,  and  diphtheria.  Before 
the  era  of  vaccination,  smallpox  was  also  principally  a 
disease  of  childhood,  and  produced  its  greatest  mortal- 
ity among  those  under  five  years  of  age.  Thus  in  "  Ge- 
neva from  1580  to  1760  there  were  25,349  deaths  from 
smallpox,  and  of  these  21,078  were  under  five  years 
old  and  961  per  1000  were  under  ten  years  old.    In 


AIR   AND  FOMITES   BORNE  DISEASES     241 

Edinburgh  in  1764-83,  the  proportion  under  ten  years 
old  was  993  per  1000,  In  the  Chester  epidemic  of  1774 
there  were  202  deaths,  all  among  children  under  ten 
years  old."  All  of  these  diseases  do  attack  adults,  how- 
ever, though  less  frequently  and  usually  less  severely 
than  children. 

Season  exercises  some  influence.  The  cold,  raw 
weather  of  the  late  winter  and  early  spring  particularly 
favor  most  of  them,  while  they  are  also  common  in  win- 
ter and  rather  rare  in  summer. 

Crowding  favors  epidemics,  quite  apart  from  the 
question  of  ventilation,  and  it  also  predisposes  to  severe 
attacks.  Many  cases  of  a  very  severe  type  of  measles 
developed  in  the  concentration  camps  in  1898.  School 
epidemics  of  measles,  German  measles,  scarlet  fever, 
mumps,  and  diphtheria  are  rather  common. 

Poor  hygienic  conditions,  such  as  dirty  surroundings, 
the  breathing  of  effluvia  from  decomposing  matter,  and 
bad  ventilation,  are  all  thought  to  predispose  to  them. 

Unknown  atmospheric  conditions  apparently  influ- 
ence the  rise  and  fall  of  some  of  them.  Influenza  and 
diphtheria  increase  and  decrease  in  ways  thus  far  not 
fully  explained. 

A  previous  attack  of  one  of  these  diseases  usually 
protects  from  a  second,  but  such  is  not  the  case  in  all  of 
the  group.  One  attack  of  diphtheria  or  influenza,  for 
instance,  seems  to  predispose  to  a  second  rather  than  to 
protect  against  it.  Second  attacks  of  smallpox,  scarlet 
fever,  and  mumps  are  rare,  those  of  measles  less  so. 

These  diseases  are  not  all  transmitted  in    -iiir  ^i^    j 

exactly  the  same  way,  but  the  transfer  of      ,  _  , 

no  one  of  them  is  so  liinited  as  the  title  of 
11  1 1  •    T  1  mission 

the  chapter  would  indicate  ;  so  the  various 


242       THE   PREVENTION   OF  EPIDEMICS 

methods  will  be  considered  and  the  exceptions  noted 
as  we  progress. 

Some  of  these  affections  are  truly  contagious,  as  the 
word  was  defined  earlier  in  the  chapter.  Mere  approach 

.  to  the  patient  and  breathing  of  the  air  sur- 

rounding him  in  a  greater  or  smaller  zone 
seems  sufficient  to  allow  infection  by  smallpox,  measles, 
scarlet  fever,  typhus,  German  measles,  mumps,  whoop- 
ing-cough, and  oftentimes  influenza.  In  some  of  these 
instances,  and  in  diphtheria,  meningitis,  and  some  other 
diseases,  the  infection  may  occur  through  the  inhalation 
of  dust  or  of  droplets  of  sputum  expelled  in  coughing, 
and  which  contain  the  organisms.  In  measles,  mumps, 
smallpox,  and  scai4et  fever  this  is  not  always  the  case, 
and  the  only  explanation  that  will  account  for  their 
high  degree  of  contagiousness  is  that  the  virus  is  float- 
ing in  the  air  in  an  impalpable  and  unidentified  form. 
It  may  even  be  carried  to  a  considerable  distance  at 
times,  and  smallpox  hospitals,  in  particular,  are  apt  to 
be  a  menace  to  their  neighborhoods.  It  is  not  under- 
stood how  other  aerial  conveyance  than  by  droplet  or 
dust  infection  can  well  occur  in  influenza,  yet  the  rapid- 
ity with  which  the  epidemic  of  1889-90  spread  over 
the  whole  world  makes  it  seem  possible  that  such  exists. 
The  periods  during  which  these  diseases  are  most  conta- 
gious vary  considerably  and  will  be  discussed  later. 

The  contagious  principles  of  most  of  the  group  here 
discussed  are  well  known  to  cling  to  such  inanimate 
articles  as  books,  clothing,  bedding,  and 
carpets,  and  they  may  sometimes  be  pre- 
served in  these  things  for  considerable  periods.  Toys 
may  serve  as  the  transferring  medium,  and  measles, 
German    measles,   diphtheria,   and  scarlet  fever  have 


AIR  AND   FOMITES   BORNE  DISEASES     243 

often  been  conveyed  by  them.  Handkerchiefs  and 
clothing  soiled  by  the  nasal  discharges,  expectoration,  or 
skin  effluvia  of  the  sick  are  particularly  dangerous.  It 
is  often  extremely  difficult  to  draw  hard  and  fast  lines 
separating  pure  contagion  (in  the  above  defined  sense), 
dust  and  droplet  contagion,  fomites-conveyance,  and 
contagion  by  contact.  Where  there  has  been  a  possi- 
bility of  infection  in  one  of  these  ways,  there  have  often 
been  other  opportunities  for  it. 

Contact-infection  we  know  to  be  possible  in  all  of 
them,  though,  and  kissing  or  sleeping  with  a  person 
with  any  of  the  diseases  under  discussion  is 
particularly  dangerous.  They  are  dangerous 
cases  to  nurse  or  to  treat,  and  nurses  and  doctors  often 
contract  them,  and  would  do  so  much  oftener  except 
for  the  protecting  influences  of  previous  attacks,  age, 
and  constant  sanitary  precautions. 

The  virus  of  most  of  these  affections  is  given  off  in 
the  spit  and  nasal  secretions  of  persons  suffering  from 
them.  Such  is  certainly  the  case  in  diph- 
theria,  scarlet  fever,  measles,  mumps,  and  '^ 
sometimes  in  meningitis,  and  it  may  be  true  of  all  the 
others.  Such  relations  as  bring  healthy  persons  into 
contact  with  these  substances  are  therefore  particularly 
dangerous,  and  the  handling  or  using  of  towels,  hand- 
kerchiefs, and  similar  articles  used  by  the  sick  is  to 
be  carefully  avoided.  Droplets  of  sputum  or  mucus 
expelled  by  coughing  or  speaking,  and  the  inhalation 
of  them,  are  frequently  a  cause  of  disease.  One  case  of 
diphtheria  or  measles  in  the  early  stage,  and  showing 
no  symptoms  except  cough  or  "  cold,"  may  infect  a 
whole  school  of  children,  or  a  barrack  full  of  soldiers, 
before  its  nature  is  recoguized. 


244       THE   PREVENTION   OF  EPIDEMICS 

It  is  quite  probable  that  the  virus  of  some  or  all  of 
these  diseases  may  also  be  contained  in  other  natural 
Othf  Se  secretions  of  the  patient,  or  in  pus  or  erup- 
tions that  sometimes  occur.  It  is  highly 
probable  that  the  ears  may  be  infectious 
in  measles,  and  discharges  from  the  ears  and  nose  are 
certainly  so  in  scarlet  fever.  Other  parts  of  the  body 
than  the  throat  and  nose  may  be  infected  with  diph- 
theria, and  discharges  from  them  would  be  highly  con- 
tagious. The  disease  may  attack  the  eyes,  the  genitals, 
the  rectum,  wounds,  and,  rarely,  the  sound  skin  and 
stomach. 

In  smallpox,  measles,  scarlet  fever,  German  measles, 
and  typhus,  it  is  either  certain  or  probable  that  the  virus 
_.,  .  is  given  off  from  the  skin,  and  that  contact 

with  that  may  give  the  disease,  whether  it 
be  direct,  as  in  handling  the  patient,  or  indirect,  as  in 
handling  clothing,  bedding,  or  animals  touched  by  him. 
In  several  of  these  diseases  there  is  a  marked  shedding 
of  the  upper  layers  of  the  skin  as  convalescence  begins. 
The  part  shed  may  be  in  the  form  of  thick  scabs,  as  in 
smallpox,  strips,  sheets,  or  large  scales  of  parchment- 
like skin,  as  in  scarlet  fever,  or  fine  branny  scales,  as 
in  measles  or  German  measles.  Whatever  their  form, 
these  products  are  dangerous  and  are  to  be  avoided. 

In  most  or  all  of  the  diseases  here  considered  the 

virus  is  at  some  time  contained  in  the  blood,  and  contact 

^,       ,  with  that,  as  in  dressing  wounds  or  clean- 

ing  up  spilled  blood,  would  probably  offer 

chances  of  infection. 

The  introduction  of  infectious  matter  into  wounds 
serves  to  inoculate  most  of  these  affections.  It  is  much 
resorted  to  in  efforts   to   infect   animals   for   experi- 


AIR  AND   FOMITES    BORNE   DISEASES     245 

mental  or  other  purposes,  and  in  pre-vaccination  times 
inoculation  with  smallpox  was  sometimes 
done  as  tending  to  produce  a  milder  attack 
of  the  disease  than  resulted  from  natural 
infection. 

Infection  through  the  medium  of  utensils,  such  as 
cups,  spoons,  thermometers,  bedpans,  or  pipes,  may 
readily  occur,  but  is  an  evidence  of  mediate 
contact  rather  than  of  contagion  by  virus 
contained  in  the  air.  Such  articles  can  only  rarely  con- 
vey the  disease  in  question,  unless  they  have  been 
soiled  by  contact  with  the  mouth,  skin,  or  other  portions 
of  a  patient. 

Animals  may  convey  these  diseases  in  various  ways. 

Their  hair  or  fur  may  absorb  the  poison  from  the  air 

of  the  contaminated  zone  surrounding  the       .     . 

^.     ^      T  .,  -1  ,   .       Animals 

patient  and  convey  it  as  a  window-curtain 

or  similar  article  might;  or  they  may  gather  up  in- 
fected dust,  sputum,  or  flakes  of  skin  by  lying  on  or 
near  the  sick-bed,  and,  by  shaking  themselves,  liberate 
it  elsewhere.  It  is  possible  that  they  might  lick  up  moist 
sputum  or  other  secretions,  and  retain  the  germs  alive 
in  their  mouths  and  transmit  them  through  fondling  or 
fawning,  even  though  they  do  not  themselves  have,  or 
are  not  subject  to,  the  disease.  In  other  instances  they 
are  subject  to  the  diseases,  and  may  contract  them 
through  contact  from  eating  spit,  or  in  other  ways,  and 
breed  and  give  off  germs  just  as  do  human  patients. 
Cats,  dogs,  and  many  other  animals  are  subject  to  diph- 
theria, and  may  aid  in  spreading  it.  Cows  suffer  from 
a  disease  of  the  teats  which,  it  has  been  said,  can  by 
means  of  milk  set  up  scarlet  fever  in  the  human  sub- 
ject.   Cattle  suffer  from  smallpox  in  the  mild  and  al- 


246       THE  PREVENTION   OF  EPIDEMICS 

tered  form  known  as  vaccinia  or  cowpox,  which,  when 
in  turn  inoculated  into  man,  affords  protection  against 
the  first,  or  more  severe  disease.  Whooping-cough  has 
been  transmitted  to  a  cat  by  feeding  it  the  mucus  and 
vomit  from  patients  having  that  disease. 

Epidemics  of  scarlet  fever  and  diphtheria  have  many 
times  been  traced  to  contaminated  milk,  and  it  is  not 
impossible  that  several  of  the  other  diseases 
we  are  discussing  may  likewise  be  so  con- 
veyed. The  milk  may,  in  exceptional  instances  and  in 
the  two  diseases  just  named,  be  infected  by  the  animal 
giving  it,  but  the  virus  is  usually  derived  from  some 
human  carrier  of  the  organisms.  Milk  is  a  good  cul- 
ture medium  for  most  disease-producing  bacteria,  and 
we  have  already  seen  how  important  it  may  be  in  the 
diffusion  of  typhoid  fever  and  how  readily  it  may  be 
infected  with  the  germs  of  that  disease.  It  is  therefore 
easily  conceivable  how  milk-handlers  suffering  from 
influenza,  mild  diphtheria,  mild  scarlet  fever,  or  others 
of  the  diseases  we  have  been  discussing,  might,  through 
coughing,  tasting  the  milk,  careless  handling  of  vessels, 
or  in  other  ways  introduce  germs  into  it.  Milk  epidemics 
of  scarlet  fever,  like  those  of  typhoid,  are  apt  to  show 
a  somewhat  "  explosive  "  character,  that  is,  many  cases 
develop  at  or  near  the  same  time.  Measles  is  not  thought 
to  be  milk-borne. 

The  virus  of  any  disease  having  gained  entrance  to 
a  susceptible  body,  some  time  is  required  for  its  multi- 
plication and  development,  and  for   it  to 
manifest  its  effects  on  the  body.  This  time 
between  the  entrance  of  infection  and  the 
^  appearance  of  the  first  symptoms  of  disease 

is  known  as  the  incubation  period,  and  is  more  or  less 


AIR  AND  FOMITES   BORNE  DISEASES    247 

constant  for  each  disease.  As  it  is  important  to  take  this 
into  consideration  in  attempting  to  trace,  control,  or 
prevent  epidemics,  the  following  may  be  considered 
as  representing  it  with  tolerable  accuracy  in  the  dis- 
eases named :  — 

Diseases  Incubation  Pekiods 

Smallpox     .     .     .     .     ,  8  to  20  days,  oftenest  12. 

Typhus  fever  ....  12  days  or  less. 

Chicken-pox     .     .     .     .  10  to  15  days. 

Scarlet  fever    .     .     .     .  1  to  7,  oftenest  2  to  4  days. 

Measles 7  to  18,  usually  14  days. 

German  measles  ...  14  days  or  more. 

Mumps 14  to  21  days. 

Whooping-cough       .     .  7  to  10  days. 

Influenza 1  to  4  days. 

Cerebro-spinal  meningitis  Unknown. 

Diphtheria 1  to  7  days,  usually  2. 

Tonsillitis 1  to  3  or  4  days,  usually  2. 

The  incubation  period  is  of  value  in  enabling  us  to 
approximate  the  time  and  place  of  infection  and  to  judge 
correctly  of  the  length  of  time  that  suspects 
should  be  isolated.  After  the  disease  has  ° 

developed,  however,  the  character  and  length 
of  the  isolation  period  for  the  sick  will  be 
controlled  rather  by  the  degree  of  the  con- 
tagiousness and  the  time  at  which  it  is  ° 
greatest  or  during  which  it  persists.  It  will 
therefore  be  well  to  summarize  briefly  our  knowledge  on 
those  points. 

Smallpox  is  one  of  the  most  contagious  of  diseases, 
and  priorto  the  introduction  of  vaccination  almost  every- 
body had  an  attack,  usually  in  childhood,  as  natural 


248       THE   PREVENTION   OF  EPIDEMICS 

immunity  is  very  rare.  It  is  probably  contagious  from 
an  early  stage,  and  it  continues  so  until  the  patient  has 
recovered  from  the  disease  and  has  ceased  to  desqua- 
mate or  shed  scabs.  The  contagium  is  very  persistent, 
and  clings  for  long  periods  to  infected  places  or  arti- 
cles. Varioloid  is  a  mild  form  of  smallpox,  usually  seen 
in  vaccinated  persons,  and  may  give  rise  to  the  most  vir- 
ulent type  of  the  disease  in  those  who  have  not  been 
vaccinated. 

Typhus  fever  was,  during  its  height,  considered  one 
of  the  most  contagious  of  diseases  during  all  its  course. 
There  is  at  present  a  tendency  to  attribute  its  spread  in 
former  times  to  insect  transmission,  bedbugs  and  fleas 
being  accused,  but  the  facts  are  not  determined. 

Cliicken-pox  is  probably  contagious  from  its  onset 
until  after  the  completion  of  desquamation  of  the  scabs. 

Scarlet  fever  is  most  contagious  when  the  fever  is 
highest,  but  it  is  so  even  after  the  subsidence  of  all  fever 
and  for  some  weeks  after  the  disease  has  apparently 
ended.  This  long  persisting  contagiousness  may  be  due 
in  part  to  virus  contained  in  the  desquamating  skin,  but 
it  is  probably  more  often  due  to  a  focus  of  inflammation 
persisting  in  the  nose,  throat,  or  ear.  Infected  places 
or  articles  may  retain  the  virus  for  a  long  time,  even  for 
many  months. 

Measles  is  even  more  contagious  than  scarlet  fever 
and  smallpox,  but  fortunately  the  period  during  which 
it  is  so  is  relatively  short.  It  is  most  marked  during  the 
period  of  onset  of  the  disease,  when  the  patient  shows 
no  symptoms  but  those  of  a  cold.  The  contagium  is 
more  evanescent  than  in  the  case  of  scarlatina,  and 
neither  places  nor  things  retain  it  so  long. 

The  contagium  of  German  measles  is  probably  like 


AIR  AND  FOMITES   BORNE  DISEASES    249 

that  of  measles,  active  for  a  short  time,  but  not  persist- 
ent. 

Mumps  is  contagious  for  about  two  weeks,  or  a  little 
more,  from  the  time  of  its  onset. 

Whoop'ing-cotigh  is  probably  contagious  during  the 
entire  period  of  its  existence,  including  the  early  stage 
before  the  development  of  the  whoop. 

Influenza^  likewise,  is  probably  contagious  from  the 
onset.  It  often  passes  into  a  chronic  stage,  wherein  the 
active  symptoms  have  subsided,  but  a  slight  cough  or 
some  similar  reminder  persists.  As  the  bacilli  remain 
and  may  be  expelled  hy  the  cough,  there  is  reason  to 
think  that  such  cases  may  remain  sources  of  infection 
for  indefinite  periods. 

Cerebro-S])inal  meningitis  being  due  to  an  organism 
that  may  be  found  in  healthy  noses  and  throats,  but 
one  which  possesses  but  feeble  resisting  powers,  it  is 
impossible  to  say  how  long  it  may  be  contagious.  The 
degree  of  contagiousness  is  not  high. 

Diphtheria  is  contagious  from  its  onset  vmtil  such  time 
as  the  bacilli  have  disappeared  from  the  breathing  pas- 
sages, a  period  exceeding  the  apparent  duration  of  the 
disease  by  days,  weeks,  or  months.  Different  strains  of 
the  organisms  present  decided  differences  of  virulence, 
and  this  partly  accounts  for  the  varying  grades  of  se- 
verity shown  by  epidemics.  The  virus  attaches  itself  to 
the  clothing,  the  bedding,  and  the  room  in  which  the 
patient  has  lived,  and  has  in  many  instances  displayed 
great  tenacity.  "  It  has  been  found  to  live  in  blood 
serum  for  one  hundred  and  fifty-five  days,  in  gelatine 
for  eighteen  months,  dried  on  silk  threads  for  one  hun- 
dred and  seventy-two  days,  on  a  child's  plaything,  which 
had  been  kept  in  a  dark  place,  for  five  mouths,  and  in 


250        THE   PREVENTION   OF   EPIDEMICS 

bits  of  dried  membrane  for  from  fourteen  to  twenty 
weeks.  .  .  .  Forbes  isolated  diphtheria  bacilli  from  a 
vessel  which  was  regarded  as  the  cause  of  the  disease  in 
twenty-four  families.  The  bacilli  grow  readily  in  milk 
without  changing  its  appearance." 

Tonsillitis  is  an  inflammation  of  the  tonsils  due 
to  any  cause.  It  may,  therefore,  be  diphtheritic,  but  as 
generally  used  and  as  intended  here,  the  term  signifies 
a  tonsillar  inflammation  due  to  other  organisms  than 
that  of  diphtheria,  and  applies  to  the  common  "  sore- 
throat  "  of  winter-time.  Though  neither  so  dangerous 
nor  so  highly  contagious  as  diphtheria,  it  occasions 
much  discomfort  and  may  spread  through  a  barracks 
to  a  considerable  extent,  especially  if  the  ventilation  is 
poor. 

The  prevention  and  control  of  epidemics  of  these 
contagious  diseases  naturally  rests  on  two  classes  of 
measures,  —  those  of  general  hygiene  and 
cleanliness,  and  those   directed  at  special 
features  characteristic  of  the  affections. 
The    general    measures    should    include 
good  policing  and  cleanliness  of  camps  or  barracks 
and  of  persons.  It  cannot  be  said  that  any  disease  in 
the  list  under  discussion,  with  the  exception 
of  typhus,  depends  very  directly  upon  the 
presence  of  dirt  or  filth;  yet  the  other  dis- 
ease-favoring  conditions    that   accompany 
dirt,  such  as  easier  contaminating  contact,  poor  ventila- 
tion, and  vermin,  do  favor  their  spread.    Good  policing 
is  one  indication  of  good  general  sanitation. 

Ventilation  should  at  all  times  be  abundant,  and  it 
should  be  superabundant  in  the  neighborhood  of  the 
sick,  as  it  not  only  promotes  comfort  and  health,  but 


AIR  AND   FOMITES   BORNE   DISEASES    251 

dilutes  the  poison  or  contagium,  and  so  reduces  the 
dose  of  it  that  those  in  the  neighborhood  may  inhale. 

Water  is  of  only  minor  importance  in  the  diffusion 
of  these  diseases,  but  the  supply  should  be  good  and 
special  care  should  be  used  in  disposing  of  that  which 
has  been  used  in  washing  the  sick  or  their  effects.  It 
should  be  disinfected  by  chemicals  or  heat. 

Foods^  other  than  milk,  are  seldom  responsible  for 
the  spread  of  the  diseases  considered ;  but  food  that 
has  been  in  contact  with  the  sick  should  be  carefully 
disposed  of.  The  diphtheria  bacillus,  for  instance,  might 
grow  on  meat,  bread,  potatoes,  or  other  food-articles. 

Persons  having  any  of  these  diseases  should  be  ex- 
cluded from  kitchens,  dining-rooms,  and  all  contact 
with  any  food  except  that  for  their  own  use  and  con- 
sumption. Supplies  from  bakeries,  meat-shops,  or  other 
food-distributing  places  that  harbor  persons  sick  of 
these  diseases,  are  best  avoided.  It  is  conceivable  that 
they  may  occasionally  be  transmitted  by  means  of  food 
that  has  been  exposed  for  sale  in  places  where  it  might 
be  contaminated  by  infected  dust  or  by  droplets  of  spit 
expelled  by  coughing  persons. 

Milk  is  particularly  dangerous  as  a  means  of  dis- 
semination of  scarlet  fever  and  diphtheria,  and  it  may 
possibly  act  in  a  similar  capacity  for  others  of  these 
diseases.  It  is  certainly  the  part  of  wisdom  to  exclude 
persons  having,  or  recovering  from,  or  in  contact  with, 
any  of  these  diseases,  from  handling  milk  intended  for 
the  use  of  others.  In  case  of  epidemic  the  milk-supply 
should  be  investigated,  and  steps  be  taken  to  prevent 
infection  through  it.  Pasteurization  or  boiling  will 
make  the  milk  safe  if  it  is  protected  from  subsequent 
contamination. 


252       THE   PREVENTION   OF  EPIDEMICS 

Vermin  should  be  guarded  against  as  possible  dis- 
seminators. The  spread  of  typhus  has  been  credited  to 
both  fleas  and  bedbugs,  and  it  is  conceivable  that  either 
might  carry  the  virus  of  smallpox,  scarlet  fever,  or  other 
diseases,  from  one  person  to  another.  Flies  that  pass 
from  infected  sputum  to  food-articles  or  to  well  persons 
might  also  carry  it. 

Animals,  such  as  dogs,  cats,  and  other  pets,  should 
be  excluded  from  access  to  the  sick  for  reasons  set 
forth  earlier  in  the  chapter.  The  principal  measures 
of  specific  protection  against  these  diseases  are  as  fol- 
lows :  — 

Early  diagnosis  is  absolutely  essential  for  the  con- 
trol of  most  of  them,  and  is  helpful  in  all.  Measles  is 
highly  contagious  before  the  eruption  ap- 
^  pears,  and  may  be  widely  spread  by  per- 

.     °  sons    apparently    suffering   from   "  colds." 

All  susjiicious  cases  should  therefore  be  re- 
ported to  the  surgeon  for  examination  as  soon  as  any 
symptoms  present  themselves.  As  stated  before,  com- 
pany officers  should  encourage  their  men  to  go  on  sick 
report  at  the  first  appearance  of  disease. 

Notification  of  cases  is  the  next  step  in  control.    It 

follows  diagnosis  naturally  in  the  case  of  soldiers  re- 

Nnffra      porting   to   the    surgeon;  but  occasionally 

officers  or  their  families,  or  more  rarely  en- 
tion  T       1  ,      .   .,.         ,..*', 

listed  men,  consult  civilian  physicians.    In 

such  instances  the  presence  of  contagious  disease  may 
not  be  notified  and  may  escape  official  recognition,  with 
the  consequence  that  preventive  measures  may  not  be 
adopted.  Line  officers,  enlisted  men,  and  civilian  phy- 
sicians, all  should  realize  that  the  highest  function  of 
the  medical  officer  is  the  prevention  of  disease,  and  that 


AIR  AND   FOMITES   BORNE   DISEASES    253 

they  are  preventing  his  performance  of  it,  as  well  as 
violating  orders,  when  they  do  not  promptly  report  to 
him  any  eases  of  contagious  disease  in  the  post  with 
which  they  may  be  concerned.  Unless  agreeing  to  act 
thus  fairly,  civilian  physicians  should  not  be  allowed 
to  practice  on  a  military  reservation,  and  they  cannot 
properly  do  so ;  and  officers  and  men  who  through  care- 
lessness or  design  are  responsible  for  the  presence  of 
such  diseases  on  the  post  being  unknown,  should  be 
punished. 

Notification  of  the  presence  of  any  of  the  diseases 
in  this  group  should  at  once  lead  to  an  investigation  of 
its  source,  with  the  object  of  removing  this     _ 
if  possible.  The  nature  of  the  investigation      ~^ 
will  be   indicated  by  what  has  been  said 
as  to  methods  of  infection  and  incubation  periods. 

The  sick  should  be  isolated  as  soon  as  the  diagnosis 
is  made  or  suspected.  The  character  and  duration  of 
the  isolation  will  vary  with  the  disease.  It 
should  in  all  cases  be  sufficiently  strict  to 
prevent  all  unnecessary  contact  with  the  sick,  and 
should  last  until  the  dangerous  period  is  safely  ])ast. 
Smallpox  should  be  isolated  at  some  distance  from 
dwelling  or  gathering  places,  even  at  the  expense  of 
some  inconvenience.  In  military  life  tents  make  suitable 
isolation  hospitals  unless  the  weather  is  unusually  se- 
vere. The  possibility  of  apparently  well  persons  acting 
as  carriers  must  be  borne  in  mind.  Diphtheria  patients 
and  their  attendants  must  not  be  released  from  isolation 
until  their  respiratory  passages  are  free  from  germs, 
scarlet  fever  ])atients  until  all  discharges  from  the  throat, 
nose,  and  ears  have  ceased,  and  tho  individual  has  been 
well  a  mouth  or  more.     In  all  instances  the  character 


254       THE   PREVENTION   OF   EPIDEMICS 

and  duration  of  isolation  are  matters  to  be  determined 
by  the  medical  officer.  Men  breaking  isolation  bounds 
should  be  severely  punished,  as  they  may  expose  their 
comrades  to  grave  danger.  Persons  known  to  be  ex- 
j)osed  to  these  diseases  may  properly  be  isolated,  or  at 
least  kept  under  strict  surveillance,  for  a  time  equal  to 
the  maximum  period  of  incubation.  Those  suspected  of 
having  any  of  them  should  be  isolated  until  the  diag- 
nosis is  definitely  established  in  the  negative. 

Everything  that  has  been  contaminated  by  the  use, 
association,  or  proximity  of   the  sick  should  be   disin- 

^        ,  fected  before  being  allowed  to  pass  again 

Disinfec-     ,     ^        ,.  i  f         s 

to  its  ordinary  place. 

Persons   and    animals    should    be    well 

scrubbed  with  soap  and  hot  water,  and  later  with  weak 

carbolic  or  bichloride  solution,  special  attention  being 

given  to  the  hairy  parts  and  the  hair  itself.    Sterile  or 

new  clothing  should  then  be  put  on.     Clothing  may  be 

disinfected  by  boiling,  steaming,  soaking  in  antiseptic 

solution,  or  by  formalin.    The  other  methods  are  more 

reliable  than  the  last. 

Houses  are  best  made  safe  by  washing  or  spraying 
with  warm  antiseptic  solution,  making  sure  that  all  sur- 
faces are  covered  and  all  cracks  penetrated,  and  then 
fumigated  with  sulphur  or  formaldehyde.  After  that 
they  should  be  opened  and  well  dried  and  aired.  Fresh 
calcimine  or  paint  may  then  be  applied. 

Utensils  may  be  boiled,  steamed,  or  washed  in  anti- 
septics. Letters,  books,  and  similar  articles  may  be 
sterilized  by  heat  or  by  formalin,  or  by  a  combination 
of  the  two.  The  discharges  of  the  patient  should  be 
mixed  with  formalin  or  carbolic  solution  and  allowed 
to  stand  an  hour  before  being  thrown  out.  The  spiitum 


AIR  AND  FOMITES   BORNE   DISEASES    255 

should  receive  particular  care,  as  it  causes  the  conta- 
gium  of  most  if  not  all  of  these  diseases.  The  patient 
should  only  spit  into  vessels  containing  antiseptic  solu- 
tion, and  even  then  it  is  safer  if  the  spit  be  burned. 
Handkerchiefs  and  cloths  used  to  wipe  the  mouth  or 
nose  should  be  burned  or  boiled.  Surgical  dressings 
should  be  burned. 

The  most  efficient  measure  for  the  prevention  of 
smallpox  is  the  induction  of  acquired  immunity  through 
vaccination.  The  government  very  properly  Tj,(j„ced 
demands  that  every  recruit  shall  be  vac-  Tjj.jj.„_ 
cinated,  but  occasionally  the  inoculation  -^ 
does  not  "  take  "  on  a  susceptible  man,  and 
through  a  combination  of  circumstances  he  may  escape 
its  repetition.  In  civil  life  there  is  a  considerable  agi- 
tation against  the  use  of  vaccination,  the  agitators  alleg- 
ing that  it  does  not  protect  against  smallpox,  that  it  is 
an  invasion  of  personal  rights,  and  indulging  in  several 
other  incorrect  statements.  It  is  not  purposed  to  discuss 
the  matter  at  length  here,  but  it  may  be  stated  that  the 
evidence  that  vaccination  does  protect  against  smallpox 
is  overwhelming,  and  a  belief  to  the  contrary,  however 
honest  and  earnest  it  may  be,  cannot  justify  any  one  in 
endangering  the  efficiency  and  safety  of  an  army  by  its 
neglect,  any  more  than  can  a  belief  that  ever}"  man  is 
born  with  a  right  to  smallpox  if  he  wants  it.  Any  officer 
or  man  who  in  any  way  interferes  with  the  complete  and 
thorough  vaccination  of  the  army  makes  a  great  mis- 
take and  commits  a  grave  offense. 

The  spread  of  diphtheria  may  be  partly  controlled 
by  the  use  of  antitoxin.  This  may  be  and  is  very 
generally  used  in  the  treatment  of  those  sick  with  the 
disease,  but  it  is  also  of  great  value  when  used  as  a 


25G        THE   PREVENTION   OF   EPIDEMICS 

preventive  measure.  It  is  then  injected  in  relatively 
small  doses  into  persons  brought  into  contact  with  the 
disease.  So  used,  it  greatly  lessens  the  liability  to 
infection,  and  to  severity  in  case  infection  does  occur. 
Vaccinations  and  the  use  of  preventive  injections  of 
antitoxin  have  not  yet  proved  of  value  in  protecting 
from  the  other  members  of  this  group,  though  they  may 
later  be  found  applicable  in  some  instances. 


CHAPTER  XIV 

INSECT-BORNE   DISEASES 

The  principal  human  diseases  that  are  now  known,  or 
thought,  to  be  insect-borne  are  malaria,  yellow  fever, 
filariasis,  and  dengue,  carried  by  mosquitoes,  sleeping 
sickness  by  the  tsetse  fly  in  Africa,  plague  by  fleas, 
spotted  fever  of  Montana  and  relapsing  fever  of  Africa 
by  ticks.  Kala-azar  of  India,  typhus  and  relapsing 
fever  of  Europe  and  America,  and  leprosy  have  all 
been  accredited  to  the  agency  of  the  bedbug,  and  in  the 
first  two  instances  there  is  much  probability  that  the 
parasite  is  the  actual  carrier.  The  proof  of  its  relation 
to  leprosy  is,  however,  very  slight  as  yet.  These  dis- 
eases will  be  discussed  in  groups  made  to  conform  to 
the  insects  transmitting  them. 

MOSQUITO-BORNE   DISEASES 

The  most  widespread  and  common  of  these  is  mala- 
ria. It  prevails  in  most  tropical  and  sub-tropical  coun- 
tries, and  in  some  of  them  it  produces  a  .__.  . 
great  mortality,  while  it  causes  much  suf- 
fering, weakness,  and  loss  of  time,  even  where  it  is 
less  fatal.  It  is  an  important  cause  of  sickness  in  our 
army  in  many  parts  of  our  own  country,  as  well  as 
in  Cuba,  Porto  Rico,  the  Philippines,  and  the  Isthnuis 
of  Panama. 

Since  the  beginning  of  the  Spanish- American  War 
the  knowledge  of  the  methods  of  control  of  this  dis- 
ease has  increased  so  rapidly  that  it  has  now  become 


258        THE   PREVENTION   OF   EPIDEMICS 

possible  for  us  to  make  healthy  communities  out  of 
places  formerly  notorious  for  the  certainty  and  speed 
with  which  newcomers  sickened  or  died  from  malaria. 
As  stated  in  a  previous  chapter,  there  are  at  least  three 
varieties  of  this  disease  which  differ  because  the  para- 
sites causing  them  do  so,  and  which  manifest  themselves 
in  paroxysms  of  chill,  fever,  and  sweat,  that  come  at 
twenty-four,  forty-eight,  or  seventy-two-hour  intervals. 
This  regularity  of  manifestation  is  only  shown,  how- 
ever, in  cases  of  uncomplicated  single  infections.  Owing 
to  multiple  infections  or  complicating  circumstances, 
any  one  of  these  types  of  malaria  may  show  extreme 
irregularity  and  may  be  mistaken  for  other  diseases, 
the  diagnosis  being  made  possible  only  by  examination 
of  the  blood,  and,  at  times,  with  great  difficulty.  The 
fever  may  be  continuous  and  the  general  symptoms 
such  as  to  make  the  disease  appear  much  like  typhoid. 
Or  it  may  be  manifested  as  a  neuralgia,  as  a  sudden 
attack  resembling  apoplexy,  as  anaemia,  or  in  other 
obscure  ways.  This  disease  also  exhibits  periods  of  la- 
tency, during  which  the  parasite  is  present  in  the  body, 
but  in  such  numbers  or  under  such  control  by  the  body 
forces,  that  no  signs  or  symj^toms  are  present.  When, 
however,  the  vital  forces  are  reduced,  as  by  exposure, 
overwork,  alcoholism,  or  other  disease,  the  parasites 
gain  the  ascendency  and  the  disease  may  manifest 
itself  in  a  severe  manner.  Many  natives  of  highly  ma- 
larious regions  may  be  partly  immune  and  show  no 
symptoms  even  when  harboring  very  severe  infections. 
Whatever  the  character  of  its  manifestation,  how- 
ever, the  infection  is  always  received  through  the  bite 
of  a  mosquito.  Many  officers  from  time  to  time  express 
views  to  the  contrary,  usually  basing  them  on  their  own 


INSECT-BORNE   DISEASES  259 

faulty  observations.  Occasionally  there  is  reason  to 
suspect  that  the  views  are  exploited  to  account  for  the 
presence  of  malaria  when  the  efforts  to  prevent  mos- 
quito-transmission entail  an  inconvenient  amount  of 
trouble.  The  fact  is  that  malaria  has  been  investigated 
with  a  thoroughness  that  has  been  accorded  to  few  other 
diseases,  and  the  method  of  mosquito-transmission  has 
been  abundantly  proved,  and  no  other  appears  even 
probable.  "  If,  after  they  have  imbibed  malarial  blood, 
certain  species  of  mosquitoes  be  dissected  at  serial  in- 
tervals, the  evolution  of  the  malaria  parasite  can  be 
followed  in  their  tissues,  until,  finally,  the  germs  of  the 
parasite  can  be  tracked  into  the  cells  and  secretions 
of  the  salivary  glands  of  the  insect. 

"  If  after  a  week,  or  thereabouts,  a  similarly  fed  mos- 
quito bites  a  hitherto  uninfected  man,  in  many  instances, 
after  a  few  days,  that  man  will  exhibit  the  clinical 
phenomena  of  malaria  infection  and  the  characteristic 
parasite  in  his  blood. 

"  A  non-immune,  if  effectually  protected  against  mos- 
quito bite,  will  not  contract  malarial  disease,  however 
long  he  may  live  in  highly  malarious  localities. 

"  Most  observers  are  now  of  the  opinion  that  the  ma- 
laria parasite,  under  natural  conditions,  can  be  acquired 
by  man  only  through  the  bite  of  the  mosquito  ;  that  the 
mosquito  can  acquire  the  parasite  only  by  ingesting 
the  blood  of  a  malaria-infected  man,  or  possibly  other 
mammal ;  that  there  is  no  extra-corporeal  life  other  than 
that  described  ;  that  there  is  no  authentic  instance  of 
malaria  being  acquired  in  uninhabited  places  ;  that  in 
the  case  of  malaria  in  connection  with  soil  disturbances, 
it  depends  on  the  creation  during  digging  operation  of 
puddles  of  water  in  which  mosquitoes  breed ;  and  that 


260       THE   PREVENTION   OF   EPIDEMICS 

its  epidemic  occurrence  under  these  circumstances  is 
owing  to  unhygienic  conditions  such  as  usually  prevail 
when  large  bodies  of  men,  some  of  whom  may  bring  the 
infection  with  them,  are  brought  together  on  public 
works  attended  with  extensive  earth-cutting,  as  in  rail- 
way, road,  or  canal- making." 

Several  species  of  mosquitoes  are  capable  of  trans- 
mitting the  disease,  but  they  all,  so  far  as  now  known, 
belong  to  the  sub-family  anoj^halince.  The 
_,  ,  .  ,  features  by  means  of  which  these  various 
.  species  may  be  identified  cannot  be  dis- 
^  cussed  here,  and  positive  identification  is  a 

labor  necessitating  some  time  and  effort  even  on  the 
part  of  the  specialist ;  but  a  popular  rough  method  of 
identifying  anophalinae  mosquitoes  in  general  is  that 
the  adults,  when  at  rest,  stand  with  their  bodies  almost 
or  quite  at  a  right  angle  with  the  surface  on  which  they 
are  resting,  while  commoner  species  rest  with  the  body 
more  nearly  parallel  to  the  supporting  surface.  The 
larvsB,  or  "  wigglers,"  of  the  former  class,  on  the  other 
hand,  rest  with  their  bodies  like  floating  sticks,  parallel 
to  the  surface  of  the  water  in  which  they  are  swim- 
ming. The  more  common  varieties  have  theirs  more 
nearly  at  a  right  angle  to  it.  These  mosquitoes  bite 
principally  at  night. 

This  is  an  acute  and  very  fatal  disease  that  occurs 
principally  in  tropical  and  sub-tropical  America,  though 
epidemics  also  occur  on  the  west  coast  of 
Africa,  where  the  disease  was  possibly  in- 
troduced by  slave-traders.  It  has  appeared 
in  epidemic  form  as  far  north  as  Philadeli)hia. 

Until  after  the  American  occupation  of  Cuba  and 
the  subsequent  work  of  the  board  of  army  medical  offi- 


INSECT-BORNE   DISEASES  261 

cers,  under  the  presidency  of  Major  Walter  Reed,  the 

method    of    infection   was    unknown,    and     --   .,     , 
r      .  ,.  ,  Method 

water,  contact,  loraites,  poor  police,  and  at-       ,  -, 

mosijheric  conditions  were  all  credited  as 
means.  That  Board  cleaned  up  all  obscure 
questions  as  to  the  manner  of  transmission,  and  estab- 
lished beyond  dispute  the  fact  that  yellow  fever  is  trans- 
mitted by  the  bite  of  infected  mosquitoes  of  the  species 
Stegomyiafasciata.  It  cannot  be  transmitted  by  water, 
food,  fomites,  air,  or  contact,  nor  is  its  spread  influenced 
by  poor  policing,  except  as  the  latter  promotes  the  breed- 
ing of  mosquitoes.  The  beautiful  reasoning  and  experi- 
ments which  served  to  establish  our  knowledge  of  the 
means  of  transmission  also  cleared  up  many  hitherto 
obscure  points  about  the  disease,  and,  better  still,  led 
to  the  use  of  anti-mosquito  measures  that  resulted  in  its 
eradication  from  Havana,  and  later  from  New  Orleans, 
the  Canal  Zone,  and  other  regions.  This  constituted  one 
of  the  greatest  sanitary  advances  that  the  world  has  ever 
seen,  one  making  possible  the  rejuvenation  of  Cuba, 
the  construction  of  the  Panama  Canal,  and,  it  is  hoped, 
the  civilization  and  development  of  all  tropical  America ; 
and  it  is  well  that  army  officers  should  keep  in  mind 
that  all  of  these  things  were  made  possible  by  the  fact 
that  there  happened  to  be  in  command,  in  Havana,  a 
line  officer  who  had  a  knowledge  and  an  appreciation 
of  the  importance  of  military  hygiene. 

The  Board  of  which  Major  Keed  was  the  head  showed 
that  contact,  fecal  contamination,  handling  of  fomites, 
breathing  the  close  air  breathed  by  yellow-fever  pa- 
tients in  poorly  ventilated  places,  and  all  such  tilings, 
were  incapable  of  transmitting  the  disease,  but  that 
the  bite  of  some  infected  mosquitoes  would  be  followed 


262       THE  PREVENTION    OF  EPIDEMICS 

by  the  fever  in  from  three  to  five  days,  or  occasionally 
longer.     This    is  the  ordinary  incubation- 
period  in  man,  and  accounts  for  the  fact 
f    ,  that  non-immunes  may  develop  the  disease 

so  short  a  time  after  arrival  in  places  where 
the  disease  prevails.  But  there  is  also  an 
incubation-period  in  the  mosquito,  as  shown  by  the  fact 
that  it  cannot  transmit  the  disease  until  twelve  days  after 
it  has  imbibed  the  infection  with  the  blood  of  a  sick  per- 
son. This  accounts  for  the  half-month  elapsing  between 
the  arrival  in  an  uninfected  place  of  a  case  of  yellow 
fever  and  the  appearance  of  the  first  case  of  the  subse- 
quent epidemic.  This  double  incubation  period,  three 
days  for  a  case  in  an  already  infected  district,  and  fifteen 
or  more  days  for  secondai-y  cases  in  previously  non-in- 
fected districts,  is  thus  clearly  explained. 

Not  nearly  all  mosquitoes  biting  yellow-fever  patients 
are  capable  of  transmitting  the  disease  even  after  twelve 
days,  and  the  Board  showed  that  this  was  because  of 
the  short  period  during  which  the  yellow-fever  patient 
is  infectious.  Unless  it  bites  him  during  his  first  three 
days  of  sickness,  the  insect  obtains  no  infection  and  can 
transmit  none.  It  was  also  demonstrated  that  the  cause 
of  the  disease  is  in  the  blood,  that  it  passes  through 
very  fine  filters,  and  is  probably  too  small  to  be  seen  with 
our  microscopes,  and  that  it  may  persist  in  infected 
mosquitoes  for  weeks  or  months. 

"  These  experiments  fully  explain,  1st,  the  impunity 
with  which  a  yellow-fever  patient  can  be  visited  by  a 
non-immune  if  outside  the  endemic  area :  the  mosquitoes 
in  the  vicinity  are  not  infective.  2d,  the  danger  of 
visiting  the  endemic  area,  especially  at  night :  the  mos- 
quitoes there  are  infective  and  active.    3d,  the  discrep- 


INSECT-BORNE   DISEASES  263 

ancy  between  the  incubation-period,  three  to  five  days, 
of  the  disease,  and  the  incubation-period,  fifteen  days 
and  over,  of  an  epidemic :  the  necessary  evolution  of 
the  germ  in  the  mosquitoes  infected  by  the  original 
introducing  patient  demanding  the  space  of  time  indi- 
cated by  the  difference  between  these  two  periods.  4th, 
the  clinging  of  yellow-fever  infection  to  ships,  buildings, 
and  localities :  the  persistence  of  the  germ  in  infected 
mosquitoes  which  are  known  to  be  capable  of  surviving 
for  five  months,  and  probably  longer,  after  feeding  on 
blood.  5th,  the  high  atmospheric  temperature  required 
for  epidemic  extension  of  yellow  fever :  such  tempera- 
ture favors  the  activities  and  propagation  of  the  mos- 
quito, and  is  probably  necessary  for  the  evolution  of  the 
germ  also  in  the  mosquito." 

The  mosquito  that  transmits  yellow  fever  is  a  very 
common  one  in  all  those  parts  of  America  that  show 
the  disease.  A  closely  allied  species  is  abun- 
dant in  the  Philippine  Islands.  Whether  or 
not  this  variety  is  capable  of  transmitting 
the  disease  is  not  positively  known,  but  if 
it  can  do  so  the  introduction  of  the  disease 
into  those  islands,  a  thing  quite  possible  after     " 
the  opening  of  the  Panama  Canal,  might  prove  a  dis- 
aster of  the   first  magnitude  and  a  great  addition  to 
their  already  numerous  afflictions.  The  mosquito  is  a 
small  black  one,  with  white  or  silvery  lines  and  bands 
on  the  thorax  and  legs.  There  is  a  peculiar  lyre-shaped 
figure  on  the  back  of  the  thorax  which,  together  with 
the  white  bands  on  its  legs,  makes  a  rough  diagnosis  of 
species  possible.   The  insects  particularly  prefer  low- 
lying  shores,  but  may  be  found  in  other  places.  They 
are  essentially  house-lovers,  ai"e  active  biters,  and  are 


264       THE  PREVENTION   OF  EPIDEMICS 

very  quick,  so  that  they  are  harder  to  catch  than  many 
other  varieties.  They  breed  in  small  artificial  collections 
of  water,  such  as  barrels,  puddles,  cisterns,  and  par- 
tially filled  tin  cans.  "  The  nature  of  the  water  appears 
to  be  a  matter  of  indifference  :  it  is  found  equally  in 
rain  or  waste  water,  but  more  frequently  in  water  dis- 
colored by  decaying  vegetable  matter." 

Dengue  is  a  disease  of  very  low  fatality,  but  one  which 
may  occasion  much  suffering  and  anxiety,  and  which 

_  sometimes  occurs  in  widespread  epidemics. 

Dengue       rn      j-  i 

°  ihe  disease  causes,  on  an  average,  aboui; 

one  week  of  absence  from  duty,  and  if  the  epidemic 
involves  thirty  or  forty  per  cent  of  a  command,  a  not 
unusual  figure,  the  strength  of  the  force  will  be  much 
impaired.  It  prevails  in  the  West  Indies,  the  Philip- 
pines, our  Southern  States,  and  in  most  other  parts  of 
the  tropical  and  subtropical  world.  Like  yellow  fever, 
it  is  a  disease  of  hot  weather  and  low  lands,  that  has 
prevailed  as  far  north  as  Philadelphia  in  summer- 
time. It  is  transmitted  by  a  very  common  variety  of 
mosquito,  Culex  fatigans,  and  possibly  by  other  varie- 
ties, but  not  by  contact,  food,  di'ink,  air,  or  fomites. 
The  incubation-period  is  from  three  to  seven  days, 
usually  about  four ;  the  causative  organism  is  contained 
in  the  blood,  passes  through  fine  filters,  and  is  probably 
too  small  to  be  seen  with  the  microscope.  The  disease 
resembles  yellow  fever  in  many  respects,  and  has  often 
been  confused  with  it  in  America. 

Filariasis  is  infestation  with  any  one  of  several  varie- 
ties of  filaria,  or  hair-worm,  whose  young  circulate  in 

.      .     the  blood.  It  is   thoufjlit  to  be  related  to 

elephantiasis,  but  was  sufficiently  discussed 
in  a  preceding  chaj^ter.  The  parasites  are  introduced 


INSECT-BORNE   DISEASES  265 

through  the  bites  of  mosquitoes,  one  of  the  most  com- 
mou  and  widespread  species,  Cul ex  fatlgcms,  acting  as 
a  carrier  for  at  least  two  varieties.  The  insect  bites  both 
by  day  and  by  night. 

The  prevention  of  these  mosquito-borne  diseases  rests 
entirely  upon  our  ability  to  protect  against  the  bites  of 
infected  insects,  except  in  the  case  of  mala-     . 
ria,  in  which  we  can  derive  aid  from  the     __ 
administration  of  quinine.  Our  success  then 
depends  on  anti-mosquito  measures,  and  it 
is  necessary  to  discuss  these  briefly.  Mosquitoes  breed 
only  in  water,  the  young  being  as  much  dependent  on 
that  fluid  as  are  fish  or  tadpoles.  The  Culex,  or  com- 
mon mosquito,  which  transmits  dengue  and  filaria,  and 
the  Stegomyla,  or  striped  mosquito,  which  carries  yellow 
fever,  generally  breed  in  vessels  of  water,  cisterns,  or 
drains.    The  Anopheles,  or  malarial  mosquitoes,  breed 
"mostly  in  shallow  puddles  on  the  ground,  in  small 
ponds,  in  slow  and  small  runnels  of  water,  in  pools  of 
rain  water,  on  rocks,  on  the  margin  of  slow-running 
streams,  and  sometimes,  but  rarely,  in  vessels  of  water." 

The  larvse  or  wigglers  of  all  kinds  of  mosquitoes  re- 
quire at  least  six  or  seven  days  of  life  in  water  before 
they  can  develop  into  winged  insects,  and  the  time  is 
usually  longer,  especially  if  the  weather  be  cool  or  con- 
ditions otherwise  unfavorable.  Drying  kills  them  and 
also  destroys  mosquito  eggs.  On  the  other  hand,  natural 
degrees  of  heat  and  cold  do  not  necessarily  destroy  them 
if  they  remain  in  water,  and  in  northern  latitudes  both 
larvae  and  adults  may  survive  several  freezings  during 
a  winter  and  again  become  active  when  warm  weather 
returns.  Usually  only  female  mosquitoes  suck  blood, 
and  they  do  so  because  the  rich  nutriment  hastens  the 


266       THE  PREVENTION   OF  EPIDEMICS 

ripening  of  their  eggs,  and  these  are  generally  deposited 
only  after  such  a  meal.  As  the  mosquito  fills  herself  to 
a  degree  that  greatly  increases  her  bulk  and  weight, 
and  makes  flight  laborious  and  slow,  she  usually  seeks 
a  place  near  at  hand  in  which  to  deposit  her  eggs.  Partly 
for  this  reason  it  follows  that  most  infested  houses  or 
localities  breed  their  own  mosquitoes. 

"  Mosquitoes,  especially  Anopheles,  love  thick  under- 
growth." The  facts  above  stated  indicate  the  steps  to  be 
_  taken  in  warring  ag-ainst  them,  and  of  these, 

destruction  of  breeding-places  in  or   near 
camps,   habitations,   towns,   and    garrisons 
°    is  probably  the  most  important.  The  mea- 
sures designed  to  attain  this  end  are  numer- 
ous.   Draining  and  reclamation  of  swamp  lands,  the 
Jilling  of  pools,  puddles,  and  depressions,  the  building 
of  dikes  or  embankments  to  prevent  flooding,  and  the 
clearing  or  narrowing  of  streams  to  give  them  a  more 
rapid  flow,  are  some  of  the  larger  measures  that  can 
be  profitably  employed  in  the  vicinity  of  towns  or  per- 
manent garrisons. 

But  efforts  must  not  be  confined  to  such  large  under- 
takings, because  the  chances  are  that  less  ambitious 
projects,  carried  out  in  or  about  the  dwelling,  may  ac- 
complish almost  as  much  good,  and  it  will  be  manifested 
more  promptly.  Such  local  measures  will  include  the 
filling  of  small  hollows  in  the  yard  or  about  the  house, 
or  cutting  such  outlets  from  them  that  they  will  empty 
quickly  after  rains,  filling  or  preventing  the  forma- 
mation  of  pockets  or  pools  at  the  outlets  of  drains  or 
under  faucets,  filling,  emptying,  or  obliterating  hoof- 
tracks,  wagon-ruts,  and  similar  small  depressions,  seeing 
that  fire-buckets,  fountains,  drip-pans  under  ice-chests 


INSECT-BORNE  DISEASES  267 

and  similar  water  containers  are  emptied  twice  a  week, 
and  all  larvae  contained  in  them  killed.  Empty  or  partly- 
empty  bottles,  boxes,  tin  cans,  tubs,  and  flower-pots  must 
be  removed  or  placed  in  such  positions  or  conditions 
that  they  will  not  catch  and  hold  water.  Useless  joints 
or  sections  of  bamboo  must  be  removed,  and  pieces  that 
are  in  use  or  that  form  parts  of  buildings  should,  if  open, 
be  bored  at  the  lowest  level  of  the  joint  so  as  to  let  all 
water  run  out.  The  water  in  tins  or  saucers  under  table- 
legs  or  elsewhere  as  a  protection  from  ants  should  be 
kept  clean  and  free  from  larvae.  It  would  be  well  to  have 
such  things  filled  with  antiseptic  solution  rather  than 
plain  water.  Sagging  eave-troughs  and  drain-pipes  and 
catch-basins,  that  do  not  empty  promptly,  may  afford 
breeding-places,  and  should  therefore  be  made  right. 
Banana  plants  afford  quite  sufficiently  large  receptacles 
for  breeding  water  at  the  points  where  the  leaves  di- 
verge from  the  main  stalk,  and  trees  may  provide  them 
in  knot-holes.  All  such  places  must  be  investigated  and 
faults  corrected.  Irrigating  ditches  should  run  freely 
and  with  a  good  current  when  in  use,  and  should  drain 
dry  at  other  times.  They  should  not  present  stagnant 
pools  at  any  time.  Thick  underbrush  and  high  grass 
should  be  cut  and  cleared  away,  as  it  not  only  shelters 
and  harbors  the  grown  mosquitoes,  but  hides  and  pre- 
serves small  collections  of  water  and  keeps  them  from 
drying.  Cisterns,  shallow  wells,  rain-barrels,  and  other 
large  useful  containers  of  water  should  be  screened  or 
tightly  covered  so  that  mosquitoes  cannot  gain  access 
to  them.  Privies  and  cesspools  should  likewise  be  pro- 
tected by  netting  or  tight  covers,  so  as  to  keep  them 
free  from  the  insects,  and  drain  outlets  should  empty 
on  smooth  rocks,  or  be  otherwise  so  arranged  that  pools 


268       THE  PREVENTION  OF  EPIDEMICS 

and  puddles  are  not  formed  by  their  discharge.  Other 
precautions  may  be  necessary  and  the  circumstances 
may  suggest  them.  The  object  to  be  kept  in  mind  is 
the  doing  away  with  all  stagnant  water. 

Many  of  the  measures  outlined  above,  such  as  drain- 
ing pools  and  emptying  fire-buckets,  are  destructive  of 
_  larvae  in  that  they  allow  these  to  dry.    In 

,  some  instances,  however,  it  is  not  possible 
-  to  do  those  things,  and  other  methods  of 

destroying  larvae  must  be  resorted  to.  Mos- 
quito larvae,  like  all  other  living  creatures,  have  their 
natural  enemies,  and  these  may  be  utilized.  Many 
varieties  of  small  fish  devour  them,  and  some  of  these, 
for  instance  the  "  millions  "  of  Bermuda,  are  said  to  do 
the  work  so  thoroughly  as  to  quite  prevent  mosquito 
development  in  ponds  stocked  with  them.  Many  vari- 
eties of  fish  are  useful  for  this  purpose,  and  ponds, 
streams,  and  marshes  that  create  mosquito  nuisances 
can  be  profitably  stocked  with  them.  Other  water 
animals,  such  as  tadpoles  and  some  kinds  of  heetles, 
also  eat  them,  and  their  growth  may  be  encouraged  foy 
the  purpose. 

Moulds  and  other  germs  may  also  attack  the  larvae 
and  cause  their  death  through  disease.  Such  factors 
often  make  the  task  of  artificially  rearing  mosquitoes 
for  experimental  work  one  of  some  difficulty,  but,  so 
far  as  known,  they  have  not  been  used  to  reduce  their 
natural  occurrence.  That  the  natural  enemies  are  not 
alone  sufficient  to  destroy  all  larvae  is  evident  from  the 
fact  that  the  latter  are  occasionally  numerous  in  waters 
abounding  with  fish  and  tadpoles. 

Chemical  poisons  may  also  be  used,  but  they  are  dan- 
gerous and  can  only  be  applied  to  waters  which  are  not 


INSECT-BORNE  DISEASES  269 

needed  and  which  should,  therefore,  be  drained  away  or 
otherwise  disposed  of. 

OiU  preferably  crude  jietroleum^  is  therefore  much 
used  as  a  means  of  destroying  larvae.  It  acts  mechani- 
cally. The  larvae,  though  living  in  water,  are  air-breath- 
ers, and  must  come  to  the  surface  at  intervals  of  a 
minute  or  so  for  that  purpose.  They  breathe  through 
a  small  pijJe  or  tube  which  rises  above  the  back  near 
the  tail,  and  which  is  projected  from  the  surface  of  the 
water  when  air  is  to  be  taken  in.  If  the  water  be  covered 
with  a  film  of  oil,  this  little  tube  becomes  clogged  with 
the  latter  as  it  passes  through  it,  and  respiration  is  hin- 
dered or  prevented  so  that  the  wriggler  dies  of  suffoca- 
tion. Other  oils  will  answer  as  well,  but  crude  petroleum, 
because  of  its  cheapness,  harmlessness  in  the  amounts 
used,  and  its  slow  evaporation,  is  preferred.  Refined 
kerosene  spreads  more  rapidly  and  evenly,  but  it  also 
evaporates  more  readily.  The  oil  may  be  applied  by 
sprinkling,  spraying,  or  "  painting  "  it  over  the  surface. 
In  the  last-named  method  it  is  applied  by  means  of  a 
saturated  rag  on  a  pole  that  is  rubbed  or  brushed  about 
on  top  of  the  water.  So  long  as  the  surface  is  well  cov- 
ered the  method  of  application  does  not  matter.  The 
applications  should  be  renewed  as  necessary,  and  the 
frequency  of  this  will  depend  on  several  factors  that 
must  be  taken  into  consideration.  A  slight  current  or  a 
prevailing  wind  may  drive  all  of  the  oil  to  one  side  of 
a  pond  or  may  remove  it  in  a  short  time.  In  such  cases 
the  renewal  must  be  more  frequent,  and  must  be  on  the 
side  from  which  the  oil  flows.  Light  oils  of  course  re- 
quire more  frequent  renewal  than  the  heavier  ones  that 
do  not  evaporate  so  readily.  The  surface  of  the  water 
should  not  be  left  uncovered  for  more  than  three  or  four 


270       THE  PREVENTION  OF  EPIDEMICS 

days.  If  the  water  be  drawn  off  through  a  pipe  run- 
ning well  under  the  surface,  oiling  does  not  injure  it 
for  household  uses  and  is  therefore  applicable  to  cisterns, 
rain-barrels,  and  other  domestic  supplies. 

Small  collections  of  larvse-containing  water  can  be 
easily  emptied  by  sweeping  or  other  means,  and  the 
larvse  promptly  die.  It  is  said  that  the  common  prickly 
pear  cactus  of  the  tropics  can  also  be  used  in  destroy- 
ing larvae.  "  The  thick,  fleshy  leaves  contain  a  muci- 
lage which  exudes  when  the  leaves  are  chopped  and 
added  to  water,  the  mucilage  rising  to  the  surface  and 
forming  a  practically  air-tight  covering  similar  to  that 
formed  by  oil." 

This  is  a  difficult  and  unprofitable  method  of  getting 

rid  of  a  mosquito  nuisance,  but  it  is  sometimes  neces- 

_  sarily  resorted  to  for  the  purpose  of  ridding 

,         houses  of  infected    insects,   those,  for  in- 

.  ,   ,  stance,  that  have  had  opportunities  to  bite 

yellow-fever  cases.  They  may  then  be  killed 

by  hand,  or  caught  under  bottles  containing  a  bit  of 

chloroform  or  other  volatile  poison ;  or,  more  effective 

still,  the  house  may  be  tightly  closed  and  fumigated 

with  burning  sulphur,  tobacco,  or  insect  powder.    The 

insects  are  killed  or  stupefied  by  the  fumes,  and  must 

be  swept  up  and  burned  after  the  house  is  opened. 

Certain  measures  have  value  as  tending  to  dis- 
courage adult  mosquitoes  and  to  cause  their  abandon- 
ment of  a  neighborhood,  even  though  not  killing  them. 
The  most  important  of  these  are  the  removal  of  stag- 
nant water  in  which  they  may  lay  their  eggs  and  the 
cutting  and  clearing  of  underbrush,  high  grass,  and 
vines  on  or  in  which  they  take  shelter  and  rest  when 
not  busy.    Smoking  and  anointing  the  hands  and  face 


INSECT-BORNE   DISEASES  271 

with  certain  volatile  oils  are  advocated  as  measures  of 

personal  protection  for  the  same  jDurpose,  but  they  are 

not  to  be  relied  upon.     A  hungry  mosquito  will  bite 

through  a  layer  of  oil,  and  the  most  enthusiastic  smoker 

cannot  produce  such  clouds  as  to  protect  his  ankles, 

hands,  the  back  of  his  neck,  and  other  parts. 

The  more  effective  method  of  protection  from  adults 

is  in  the  use  of  screening  materials  either  of  wire  or 

of  soft  fabrics.    Houses  with  wire-screened    ^ 

.    ^  11  1  Protec- 

windows    and    doors    are    in    general  use 

throughout  our  country,  and  add  enor- 
mously  to  the  comfort  and  safety  of  life  in 
the  hot  season.  They  are  still  great  rarities  in  the  Phil- 
ippines, however,  and  the  fact  that  we  have  been  there 
for  over  ten  years  and  have  suffered  for  that  time  from 
malaria,  dengue,  and  endless  vexation  of  body  and 
spirit,  but  still  keep  our  soldiers  in  unscreened  barracks 
and  quarters,  is  much  to  our  discredit.  We  know  bet- 
ter, but  do  not  live  up  to  our  lights,  and  therefore,  as  a 
people,  we  deserve  what  we  suffer,  except  that  those 
who  suffer  most  are  not  responsible. 

Bed-nets  are  in  general  use  throughout  all  barracks 
in  the  tropics,  and,  if  in  good  condition  and  properly 
cared  for,  they  offer  adequate  protection  during  sleep- 
ing hours,  unless  the  sleeper  rolls  or  tosses  in  such  a 
way  as  to  bring  part  of  his  person  against  the  net,  in 
which  event  the  insects  feed  through  it.  It  is  neither 
pleasant  nor  practicable  to  spend  all  of  the  day,  or  even 
most  of  it  in  bed,  and  bed-nets  are  therefore  inadequate. 

Head-nets  are  at  times  of  value  for  night  use  in  cam- 
paign, and  rarely  so  for  common  use  in  the  daytime. 
Most  mosquitoes,  though,  do  not  bite  out  of  doors  in 
the  daytime,  especially  persons  who  are  in  motion. 


272       THE  PREVENTION   OF  EPIDEMICS 

Adequate  clothing  is  of  course  important  in  protect- 
ing from  mosquito  bites,  and  should  be  used  for  that 
_  purpose.    In  spite  of  all  precautions  an  oc- 

,         casional  mosquito  will  manage  to  bite  the 
^_.  .       most  careful  man.    It  is  therefore  impor- 

jVEOSQUl' 

,  tant  to  see  that  the  insects  do  not  become 

_  ,  ..  infected  with  disease,  and  yellow  -  fever, 
Infection    ,  ,        ,    .     '    .       -^         .    ^    ^ 

dengue,  and  malaria  patients,  particularly 

the  first-named,  should  be  kept  screened  or  doubly 
screened  during  the  entire  time  that  they  are  capable 
of  giving  infection.  For  this  purpose  it  is  essential  that 
all  cases  be  known,  and  early  diagnosis  and  prompt  noti- 
fication are  therefore  important,  especially  in  yellow 
fever,  which  is  so  deadly  and  yet  is  infectious  only  in 
its  early  stages.  In  addition  to  screening,  the  malarial 
patient  should  be  taking  quinine  to  free  his  blood  from 
germs.  As  natives  of  malarious  regions  are  very  apt  to 
harbor  the  parasite  in  their  blood  and  to  keep  the  mos- 
quitoes in  their  neighborhoods  infected,  it  is  important 
to  keep  them  away  from  barracks  and  healthy  house- 
holds, and  it  is  wise  to  build  dwellings  or  barracks  at 
some  distance  from  native  towns  or  habitations.  Na- 
tives working  about  soldiers'  quarters  should  be  re- 
quired to  take  quinine  regularly  and  to  observe  the 
general  rules  of  hygiene. 

Quinine  has  been  much  and  successfully  used  as  a 

preventive  of  malaria.     The  Italian  government  has 

.    .  made  the  most  extensive  use  of  it,  holding 

^  a  monopoly  on  the  drug  and  selling  it  very 

.•^  ^"      cheaply  or  giving  it  to  the  poor.   The  value 

of  the   measure  is  so  well  established  that 

there  need  be  no  hesitation  about  prescribing  it  by 

order  in  very  malarious  regions  and  in  tropical  cam- 


INSECT-BORNE   DISEASES  273 

paigns.  The  drug  should,  for  this  purpose,  be  given 
daily  in  doses  of  from  two  to  five  grains.  Thus  adminis- 
tered after  meals,  it  will  produce  no  symptoms  and  will 
prevent  the  disease  in  many  instances. 

Experience  indicates  that  the  work  of  mosquito  "ex- 
termination "  is  more  effectively  done  if  regular  forces 
are  kept  at  it  to  the  exclusion  of  other  work, 
and  every  tropical  or  mosquito-infected  post 
should  have  such  a  "  mosquito   brigade."    !^  . 
Men  kept  on  the  work  soon  learn  the  lo-  ° 

cations  and  habits  of  the  insects  and  become  expert  in 
destruction  or  prevention.  When  the  work  is  left  to 
householders  or  to  general  fatigue  parties,  it  is  usually 
neglected  and  the  plague  continues  unabated. 

TLEA-BORNE   DISEASES 

Bubonic  plague  is  the  most  important  disease  trans- 
mitted to  man  by  fleas,  and  it  will  be  discussed  here 
only  briefly,  as  mention  has  already  been  _. 
made  of  it.  The  disease  is  due  to  a  small 
bacillus  that  is  possessed  of  great  vitality,  so  that  the 
virus  may  persist  for  a  long  time.  Extensive  investiga- 
tions in  different  parts  of  the  world,  but  principally  in 
India,  have  clearly  demonstrated  that  the  disease  is 
usually  transmitted  in  the  manner  here  indicated, 
though  it  may  occasionally  be  communicated  in  other 
ways.  The  relation  of  rats  to  plague  epidemics  has  al- 
ready been  discussed.  A  Russian  observer  states  that 
bedbugs  also  may  transmit  it.  The  germs  are  excreted 
by  plague  patients  in  the  spit,  urine,  the  pus  from  ulcers 
and  buboes,  and  possibly  the  feces,  so  that  dust-infec- 
tion and  contact  may  account  for  some  cases.  Never- 
theless the  rat  and  the  rat  flea  are  responsible  for  the 


274       THE  PREVENTION   OF  EPIDEMICS 

majority  of  cases  and  probably  for  all  epidemics,  and 
the  measures  of  prevention  and  control  are  aimed  at 
these  two.  The  following  facts,  among  others,  constitute 
the  reasons  and  justification  for  such  measures. 

Rats  abound  particularly  in  houses  and  neighbor- 
hoods which,  because  of  poor  policing  or  other  sanitary 
neglect,   afford    them   food,    shelter,    and 
(  rp  breeding-places.  They  are  very  susceptible 

to  plague  and  are  probably  the  natural 
hosts  of  the  disease.  When  severely  in- 
fected they  may  have  the  germs  in  their  blood  in  enor- 
mous numbers,  as  many  as  100,000,000  in  a  cubic 
centimetre  of  blood.  All  rats  have  fleas,  which  remain 
on  them  until  death,  when  they  leave  them  and  seek 
other  hosts,  usually  rats,  but  in  their  absence  men  or 
other  animals.  Fleas  breed  in  the  nests  of  their  hosts, 
live  on  their  blood,  and  in  biting  may  readily  ingest 
as  much  blood  as  may  contain,  in  the  case  of  plague 
septicemia,  5,000  plague  bacilli.  These  bacilli  may  re- 
main alive  and  virulent  in  the  flea's  stomach  for  as 
long  as  fifteen  days,  and  then  be  ejected  when  the  flea 
bites  again  and  gain  entrance  to  the  wound  made  by 
the  insect,  thus  producing  infection. 

While  the  rat  flea  is  the  insect  principally  concerned 

in  carrying  the  disease,  dog,  cat,  and  human  fleas  may 

act  the  part.  The  following  is  the  ordinary 

life  history  of  the  rat  flea  in  Bombay.  The 

_^    ^ eo:o:s  are  laid  at  all  seasons,  from  one  to 

Ra.t  F169.  .  . 

five  at  a  time,  and  hatch  in  about  two  days. 

The  larvae  are  wormlike  and  resemble  some  small  fly 

and  weevil  larvae.    They    live  on  almost  any  kind   of 

refuse,  and,  after  varying  periods  of  not  less  than  one 

week,  spin  cocoons  of  fine,  silky  thread,  which  become 


INSECT-BORNE   DISEASES  275 

covered  with  dust  and  rubbish  and  are  difficult  to  dis- 
tinguish. The  adult  fleas  escape  from  these  cocoons 
after  one  or  two  weeks  and  seek  a  host,  as  they  can 
only  live  on  fluid  food,  especially  blood.  The  most  fa- 
vorable temperature  for  breeding  is  from  50°  to  85^^  F., 
and  when  the  mean  is  above  or  below  this  range,  breed- 
ing stops  or  is  delayed,  a  fact  which  partly  accounts  for 
the  seasonal  variations  of  epidemics.  Each  species  of 
flea  has  its  own  host,  which  it  prefers  to  all  others,  but 
in  the  absence  of  that  host,  and  after  a  period  of  starva- 
tion, it  will  seek  others.  The  rat  flea,  for  instance,  will 
not  usually  bite  man  until  three  days  after  the  death  of 
its  rat  host. 

The  measures  to  be  taken  for  the  prevention  and  sup- 
pression of  epidemics  are  indicated  by  the  facts  recorded 
above.    They  must  embrace  numerous  and     „ 
costly  expedients  unless  the  fight  is  begun 
in  earnest  at  the  first  appearance  of  cases, 
and  the  disease  eradicated  before  it  has  had       . 
an  opportunity  to  spread.    Failure  to  take  . 

vigorous  action  early  resulted  in  the  spread  ,  . 
of  plague  through  San  Francisco,  so  that 
the  work  and  expense  of  fighting  it  have  had  to  be  con- 
tinued for  eight  years.  Similar  failure  of  early  action 
has  been  followed  by  the  spread  of  the  disease  through 
India  to  such  an  extent  that  from  November  24, 1906, 
to  November  9,  1907,  there  were  in  that  country  1,394,- 
947  cases,  of  which  1,276,576  were  fatal,  and  the  end 
is  not  yet  in  sight. 

General  hygiene  is  of  great  importance  as  lessening 
the  numbers  of  both  rats  and  fleas,  both  of  which 
abound  in  the  presence  of  filth.  Such  measures  must 
include  the  removal  or  destruction  of  rubbish  and  other 


276       THE  PREVENTION  OF   EPIDEMICS 

material  in  which  the  rats  hide  or  make  their  nests,  the 
stopping  of  their  holes  or  other  means  of  access  to  walls, 

floors,  and  other  hiding-places,  the  preven- 

tion  of  their  access  to  garbage  and  other 

^°  food-supplies.    They  must  also  include  such 

cleanliness  of  persons,  domestic  animals,  houses,  streets, 

and  communities,  as  wilL  make  the  presence  of  fleas, 

bedbugs,  and  lice  improbable. 

Special  measures  should  also  be  adopted  against  rats, 
such  as  their  destruction  by  poisoning,  trapping,  and 
,,  disease.    The  last-named  measure  is    em- 

ployed  by  scattering  bait  contaminated  with 
^  cultures  of  a  bacillus  that  causes  epidemics 

among  rats,  but  does  not  harm  man  or  his 
domestic  animals.  The  keeping  of  cats  has  been  advo- 
cated as  a  useful  anti-plague  measure,  and  it  is  prob- 
ably of  value.  Old  and  rat-riddled  buildings  may  need 
to  be  destroyed.  Good  buildings  should  be  made  rat- 
proof  by  means  of  concrete,  cement,  and  sheet-iron. 
Stables  and  warehouses  will  require  particular  atten- 
tion, and  their  floors,  walls,  and  roofs  should  be  made 
as  rat-proof  as  possible.  Because  of  the  frequency  with 
which  rats  are  transported  in  ships,  all  wharves  and 
docks  must  be  freed  from  them  as  far  as  possible,  ships 
from  infected  ports  should  be  required  to  anchor  off- 
shore, and  all  cables  or  chains  leading  to  shore  or  to 
other  boats  should  be  provided  with  shields  that  rats 
cannot  pass.  Sewers  should  be  well  flushed  to  keep 
them  clean,  and  should  be  screened  or  barred  so  that 
rats  may  not  pass  from  them  to  houses  or  other  build- 
ings. Houses  or  boats  known  to  be  infested  should  be 
tightly  closed  and  fumigated  with  sulphur  fumes  or 
other  poisonous  gas  that  will  destroy  the  rats. 


INSECT-BORNE   DISEASES  277 

The  most  important  measures  against  fleas  are  prob- 
ably good  general  policing,  the  maintenance  of  clean 
floors,  and  the  absence  of  litter  and  waste     ,. 

in  which  thev  may  breed  ;  but  other  mea- 

surGS 
sures  are  also  of  value,  and  among   them 

may  be  mentioned  the  use  of  insect-powder  ^ 
and  antiseptic  soaps  on  domestic  animals, 
the  use  of  foot-covering  and  other  adequate  clothing, 
and  the  use  of  petroleum  on  floors  and  streets,  and  of 
putty,  paint,  and  antiseptic  solutions  in  cracks  of  floors 
and  walls.  The  use  of  petroleum  is  fairly  common  in 
the  tropics  now,  as  a  protection  from  ants  principally, 
but  it  will  probably  be  as  valuable  against  fleas.  As 
previously  suggested,  the  use  of  crude  oil  in  road-mak- 
ing, as  is  now  much  practiced  in  this  country,  will  pro- 
bably prove  of  value  in  lessening  the  number  of  fleas. 
Fleas  may  be  collected  in  rooms  or  houses  known  to 
be  infected  by  turning  guinea  pigs  loose  in  them.  The 
fleas  attack  the  animals,  and  may  then  be  stupefied  with 
chloroform,  combed  from  the  hair,  and  burned. 

Every  case  of  plague  in  man  or  rat  should  be  promptly 
reported,  so  that  proper  measures  of  isolation,  fumiga- 
tion, disinfection,  etc.,  may  be   instituted 
early.  All  rats  found  dead,  as  well  as  those 
trapped  or  otherwise  captured,  should  be 
tasfsred  with  a  statement  of  the  time  and 
place,  and  then  examined  for  the  presence  of  plague. 
If  it  is  found  that  they  have  the  disease,  active  measures 
must  be  begun  at  once  in  the  neighborhood  from  which 
they  came.  All  persons  afflicted  should  be  isolated  and 
their  discharges  cared  for.   Disinfection  of  houses  and 
effects  should  follow. 

Anti-plague  vaccination  has  been  considerably  used 


278       THE  PREVENTION  OF   EPIDEMICS 

in  India  for  some  time  now,  and  the  following  state- 
ments as  to  results  have  been  published : 
"  1.  In  a  native  of  India,  who  is  more  sus- 
ceptible to  the  disease  than  Africans,  Euro- 
peans and  some  other  races,  the  inoculation  now  in  force 
reduces  the  liability  to  attack  to  less  than  one  third  of 
what  it  is  in  a  non -inoculated  Indian.  2.  In  the  one  third 
of  cases  which  still  occur,  the  recovery  rate  is  at  least 
double  that  in  the  non-inoculated  attacked.  The  ulti- 
mate result  is  a  reduction  of  plague  mortality  by  some 
eighty-five  per  cent.  3.  In  an  inoculated  European  an 
attack  of  plague,  if  it  subsequently  occurs,  has  so  far 
always  ended  in  recovery.  4.  The  inoculation  is  appli- 
cable to  persons  already  infected  and  incubating  plague, 
and  prevents  the  appearance  of  symptoms  or  else 
mitigates  the  attack."  These  claims  are  made  by  the 
originator  of  the  method,  and  his  opinion  may  possibly 
be  unduly  optimistic. 

FLY-BORNE   DISEASES 

In  addition  to  typhoid  and  other  diseases  discussed 

in  preceding  parts  of  this  book,  in  which  the  fly  acts 

.  as  a  simple  carrier  of  infection  but  does 

^       "    S     not  actually  introduce  it  into  the  body,  the 
Sickness     ,      .        •  i  t   xt  ■      • 

sleeping  sickness  ot  Airica  is  a  very  im- 
portant disease.  It  is  introduced  by  a  biting  fly,  and  is 
caused  by  a  small  animal  parasite  very  much  like  that 
causing  surra  in  horses  in  the  Philippines  and  other 
places.  Professor  Koch  also  thinks  that  the  disease 
may  be  transmitted  by  sexual  intercourse.  The  flies  con- 
cerned are  found  only  in  thick  underbrush  near  water, 
and  Koch  has  also  suggested  that  they  obtain  the  organ- 
isms in  the  first  place  from  crocodiles.   The  disease  is 


INSECT-BORNE   DISEASES  279 

almost  uniformly  fatal,  is  spreading  rapidly,  and  is 
being  thoroughly  investigated.  The  only  means  of  pre- 
vention yet  known  are  the  avoidance  of  fly-bites,  the 
cleaning  of  undergrowth  from  near  streams,  and  the 
avoidance  of  infected  localities.  It  is  improbable  that 
our  army  will  ever  have  any  experience  with  this  disease, 
but  other  ajBfections  due  to  biting  flies  may  be  discov- 
ered and  the  possibility  should  be  kept  in  mind. 

TICK-BORNE   DISEASES 

The  most  important  tick-borne  diseases  that  have 
been  well  studied  are  the  African  relapsing  fever,  due 
to  a  spirillum,  and  the  spotted  or  tick  fever  of  western 
Montana,  due  to  an  unknown  organism.  The  latter  dis- 
ease may  affect  American  troops,  as  Fort  Missoula  is 
in  the  country  in  which  it  occurs.  No  case  has  yet 
appeared  in  a  soldier.  Both  of  these  diseases  may  be 
transmitted  by  ticks  that  have  bitten  sick  persons,  or 
by  the  young  of  such  ticks.  The  methods  of  prevention 
thus  far  known  to  be  of  value  are  the  avoidance  of  in- 
fected districts  and  of  tick  bites.  In  the  case  of  spotted 
fever  the  season  is  short  and  the  danger  is  slight,  except 
from  the  first  of  March  to  the  middle  or  end  of  July. 
If  infected  regions  must  be  visited,  the  use  of  adequate 
clothing  and  of  head-nets  and  bed-nets  will  be  of  value, 
but  probably  not  absolutely  protective.  Wood-ticks, 
such  as  convey  spotted  fever,  disappear  as  forests  are 
cleared  and  the  land  cultivated.  The  ticks  that  convey 
the  African  fever  abound  principally  in  rest-houses  and 
old  camps,  and  cleanliness,  avoidance  of  old  huts  and 
old  camp-sites,  and  the  use  of  nets,  would  seem  the  best 
measures  of  protection. 


280       THE  PREVENTION   OF  EPIDEMICS 

DISEASES    BORNE    BY    BEDBUGS 

As  stated  above,  a  number  of  diseases  have  been 
credited  to  the  agency  of  these  pests,  and  the  evidence 
incriminating  them  is  sufficiently  strong  to  make  their 
avoidance  and  destruction  a  necessity,  as  well  as  an 
aesthetic  measure.  They  are  so  generally  recognized 
as  vermin  and  indicators  of  uncleanliness  that  their  pre- 
sence constitutes  a  cause  of  shame  in  a  well-regulated 
house  or  barracks.  The  avoidance  of  diseases  trans- 
mitted by  them  depends  on  scrupulous  cleanliness  of 
houses,  beds,  and  bedding,  and  the  avoidance  of  those 
that  are  not  clean.  Soldiers,  though  living  in  clean  sur- 
roundings, may  expose  themselves  to  bites  in  seeking 
sexual  indulgence  or  drink,  and  they  should  be  taught 
by  precept  and  example  not  to  do  so. 


CHAPTER  XV 

VENEREAL   DISEASES 

The  term  venereal  is  usually  applied  to  the  diseases 
resulting  from  illicit  and  impure  sexual  intercourse. 
The  principal  members  of  tlie  group  are  syphilis, 
chancroid  or  soft  chancre,  and  gonorrhoea.  In  a  gen- 
eral sense  the  adjective  is  truly  descriptive,  but,  as 
stated  before,  it  is  not  always  so,  and  all  of  these  trou- 
bles may  be  contracted  by  persons  absolutely  innocent 
of  illicit  connections  or  even  of  proper  intercourse.  It 
is,  however,  so  generally  true  that  in  soldiers,  at  least, 
the  diseases  result  from  improper  conduct,  that  they  are 
assumed  to  be  "  not  in  line  of  duty,"  and  a  report  to  the 
contrary  requires  special  explanation. 

These  diseases  are  particularly  frequent  in  youth  and 
early  manhood,  and  it  is  stated  that  "  about      _, 
95  per  cent  of  all  cases  of  gonorrhoea  occur      _, 
between  the   ages  of  sixteen  and  thirty." 
The  reasons  for  this  are  numerous,  and  some  of  them 
may  be  summarized  as  follows  :  — 

1.  This  is  the  period  at  which  sexual  desire  and 
power  are  at  their  maximum.  After  the  age  of  thirty 
some  decline  in  both  has  usually  begun. 

2.  It  is  also  a  period  in  which  judgment  is  not  ma- 
tured, self-control  not  well  developed,  and  ignorance 
not  dissipated,  so  that  the  future  wife  and  family  ex- 
ercise no  claims  and  venereal  diseases  are  regarded  as 
trifling. 

3.  Manhood  and  virility  are  synonymous  terms,  in 


282        THE   PREVENTION   OF  EPIDEMICS 

common  usage  as  well  as  in  the  dictionaries,  and  youth 
delights  in  demonstrating  its  manhood. 

4.  Most  men  are  married  by  the  time  they  reach  the 
age  of  thirty,  and  are  less  apt  to  be  exposed  to  infec- 
tion thereafter.  The  soldier  is  probably  more  apt  to 
contract  venereal  disease  than  the  young  civilian,  be- 
cause his  associates  are  practically  all  males ;  his  topics 
of  conversation  are  largely  such  as  are  only  handled  in 
"  stag  "  gatherings  ;  he  is  removed  from  the  restraints 
of  the  family  and  of  the  public  opinion  that  can  most 
influence  him,  that  of  his  friends  and  acquaintances  at 
home  ;  he  may  at  times  find  it  difficult  to  obtain  access 
to  other  female  society  than  that  of  prostitutes,  and 
these  are  always  to  be  found.  He  may  also  drink  a  bit 
to  demonstrate  his  manliness,  to  relieve  his  loneliness, 
to  be  companionable,  or  simply  because  he  is  "a  young 
man,  void  of  understanding  ";  and  then,  with  judgment 
perverted  and  desires  inflamed  by  the  alcohol,  he  for- 
gets danger  and  seeks  intercourse  where  he  can  most 
readily  obtain  it. 

These  things  are  enough  to  account  for  the  fact  that 

venereal  diseases  are  prevalent,  but  they  do  not  account 

for   the   other  humiliating  fact  that  our 

^  ^  "  army  shows  a  greater  amount  of  them  than 

any  of  the  European  services.    Many  ex- 

our     r     y    p^j^^^tions  of  this  have  been   attempted, 

but    none    of    them   seems  adequate.    One  that  may 

partly  account  for  it  is  that  American  prudery  results 

in    an  ignorance  of  sexual    matters  and    of    venereal 

diseases  such  as  does  not  obtain  elsewhere.    According 

to  the  last  annual  report  of  the  Surgeon-General  of  the 

Army,  venereal  disease  kept  an  average  of  668.65  men 

on  sick  report  during  the  entire  fiscal  year  of  1908. 


VENEREAL  DISEASES  283 

Wlieii  to  this  is  added  the  time  lost  because  of  troubles 
indirectly  due  to  venereal  diseases,  and  the  duties 
jjoorly  performed  because  of  them,  it  is  probably  no 
exaggeration  to  say  that  it  was  almost  as  though  one 
regiment  had  been  eliminated  from  the  service. 

The  company  officer  cannot  expect  to  work  a  revolu- 
tion in  the   morals  of  his  men,  or  to  make  chastity  a 
general  characteristic  of  them,  but  he  can 
exercise  some  influence  in  that  direction 
by  his  personal  conduct  and  example,  by 
choosing    non-commissioned    officers   who 
will  probably  lo  the  same,  by  making  the 
soldier's  surroundings  pleasant  and  attractive,  and  en- 
couragfinof  him  to  find  his  amusement  and  recreation  in 
the  post,  by  providing  good  reading-matter  and  help- 
ing to  make  the  most  of  the  post  exchange  as  a  place 
of  recreation  and  amusement,   and  by  giving  his  men 
instruction  as  to  the  dangers  of  venereal  disease  and  the 
sanity,  healthfulness,  and  safety  of  sexual  control  and 
continence.  Recruiting  officers  can  do  much  by  careful 
selection  of  men,  as  it  is  a  well-known  fact  that  the 
great  number  of  admissions  to  sick  report  for  venereal 
disease  is  made  up  by  a  relatively  small  number  of  men, 
the  majority  of  whom  are  of  the  less  desirable  class  of 
soldiers.    Drink,  poor   home -training,   ignorance,  and 
lack  of  self-respect  lead  these  men  to  places  and  prac- 
tices that  their  more  decent  comrades  avoid. 

As  man  is  the  only  carrier  of  these  diseases,  as  they 
are  transmitted  in  nearly  all  instances  by  direct  physi- 
cal contact,  and  as  early  diagnosis,  isolation,  and  treat- 
ment enable  us  to  do  much  in  the  control  of  other 
transmissible  diseases,  it  seems  reasonable  to  believe 
that   similar   measures,   if  generally    enforced,  would 


284       THE  PREVENTION   OF   EPIDEMICS 

produce  great  results  in  these.  There  can  hardly  be 
any  doubt  that  if  all  cases  of  venereal  disease  were 
promptly  reported  and  then  isolated  and  kept  from 
sexual  intercourse  until  well,  the  diseases  would  be  ex- 
terminated. These  are  such  chronic  troubles,  however, 
and  require  such  prolonged  and  careful  treatment  to 
insure  a  cure,  that  such  a  plan  is  quite  impracticable. 
Many  efforts  have  been  made  to  approach  it  though, 
by  the  regular  examination  of  prostitutes  and  their 
isolation  and  treatment  until  free  from  contagious 
lesions,  and  similar  measures  have  been  adopted  in  re- 
gard to  soldiers  in  our  own  service.  But  it  cannot  be 
said  that  the  diseases  have  been  brought  under  control 
by  such  measures,  and  the  reasons  are  fairly  obvious. 
It  is  practically  impossible  for  an  examiner  to  know 
positively  that  a  given  person  is  free  from  venereal 
disease.  Chancroids  are  easy  of  detection,  but  both 
syphilis  and  gonorrhoea  may  linger,  capable  of  trans- 
mission, without  giving  any  indications  of  their  presence 
that  can  be  detected  by  the  inspection  that  the  exam- 
iner of  large  numbers  can  give.  This  is  true  in  the  case 
of  soldiers,  and  much  more  so  in  that  of  prostitutes, 
who,  moreover,  are  adept  in  the  removal  of  slight  signs 
that  may  be  present,  and  whose  interest  lies  in  escaping 
isolation.  Most  prostitutes  are  such  for  one  of  two 
reasons,  either  for  the  pleasure  and  excitement  they 
find  in  the  life  or  for  the  money  they  can  make  out  of  it. 
In  either  case  their  object  is  defeated  for  the  time  be- 
ing if  they  are  isolated.  Furthermore,  there  is  always 
and  everywhere  a  large  amount  of  clandestine  prostitu- 
tion, that  is,  that  practiced  by  women  not  openly  pro- 
fessing to  do  so  ;  and  as  registration  of  the  prostitute 
is  a  necessary  preliminary  of  her  regular  examination, 


VENEREAL   DISEASES  285 

a  large  amount  of  venereal  disease  thus  escapes  detec- 
tion. Naturally,  too,  the  amount  of  this  clandestine 
prostitution  increases  with  the  severity  and  strictness 
of  the  measures  of  control  over  that  which  is  licensed. 
As  examinations  are  not  usually  made  more  than  once 
a  week,  and  in  many  instances  not  so  often,  a  woman 
may  develop  a  contagious  discharge  or  sore  the  day 
after  examination,  and  transmit  disease  to  fifty  men  be- 
fore being  examined  again.  A  prostitute  living  near  a 
Western  post  stated  that  she  usually  had  intercourse 
with  from  fifteen  to  twenty-five  men  on  the  night  fol- 
lowing payment  of  the  troops,  and  with  from  one  to  five 
or  six  men  on  other  nights. 

It  must  be  borne  in  mind  that  American  sentiment 
has  not  favored  and  possibly  never  will  favor  the  state 
control  and  licensing  of  prostitution.  Without  going 
into  a  discussion  of  the  right  and  wrong  of  the  mat- 
ter, we  are  brought  face  to  face  with  the  following  con- 
dition as  regards  the  army.  It  consists  of  aggregations 
of  men,  mostly  young,  mostly  unmarried,  and  largely 
ignorant,  who  have  abundant  opportunity  to  gratify 
their  sexual  instincts,  but  with  women  who  are  under 
little  or  no  control,  many  of  whom  are  diseased,  and 
all  of  whom  are  interested  in  avoiding  treatment  that 
involves  isolation.  The  obvious  courses  of  procedure 
are,  1st,  the  provision  of  wholesome  surroundings  and 
amusements  to  keep  the  men  away  from  dives  and  bro- 
thels ;  2d,  their  instruction  as  to  the  nature  and  dangers 
of  the  venereal  diseases,  so  that  the  large  amount  of 
these  due  to  ignorance  may  be  eliminated  ;  3d,  advice 
as  to  the  best  methods  of  avoiding  disease  in  case  they 
are  so  persistently  foolish  as  to  expose  themselves  to 
it.    The  instruction  as  to  the  nature  and  danger  of  the 


286        THE  PREVENTION   OF  EPIDEMICS 

venereal  diseases  may  be  derived  from  the  following 
consideration  of  them. 

Gonorrhoea 

Gonorrhoea  or  "  clap"  is  a  disease  of  such  great  an- 
tiquity that  it  may  be  as  old  as  prostitution  itself,  and 
the  first  half  of  the  fifteenth  chapter  of  Leviticus  indi- 
cates that  Moses  knew  it  and  also  knew  that  it  was 
conveyed  by  contact,  and  that  he  provided  rules  to  pre- 
vent its  spread. 

The  disease  is  due  to  a  bacterium  known  as  the  gono- 

coccus.  This  organism  occurs  constantly  in  the  gonor- 

_  rhceal  discharge,  and  the  disease  can  be  pro- 

Ca.usG  ...  .         .      . 

duced  by  artificial  inoculation  with  it.    It 

is  very  hard  to  cultivate  artificially,  and  is  readily  de- 
stroyed by  drying,  heat,  and  antiseptic  drugs.  It  may 
live  for  some  time  on  towels  or  linen,  or  in  warm  water. 
It  grows  on  mucous  membranes,  and  those  of  the  gen- 
ital and  urinary  passages,  of  the  eyes,  mouth,  and  rec- 
tum may  be  affected. 

The  young  are  more  susceptible  to  its  action  than 

the  old,  and  children  are  particularly  easy  of  infection. 

.  The  disease  once  started  in  hospitals  for 

children  or  in  orphan  asyhims,  especially 

among  little  girls,  is  apt  to  become  epidemic. 

Transmission  is  usually  by  sexual  contact,  but  it  may 
occur  through  mediate  transfer,  as  by  towels,  soiled 
_  hands,  penis  syringes  or  urethral  sounds. 

Such  methods  are  uncommon,  however,  and 
little  credence  can  be  placed  in  the  story  of 
the  man  who  thinks  he  got  it  from  a  water-closet  seat. 
Strain,  as  from  heavy  lifting,  can  never  cause  the  dis- 
ease, though  often  alleged  to  do  so. 


VENEREAL   DISEASES  287 

The  incubation  period  varies  considerably,  and  the 
disease  may  manifest  itself  within  a  day  of  the  impure 
connection  or  it  may  not  do  so  for  ten  or     incuba- 
tvvelve  days,  or  for  some  intervening  period,     ^jq^ 
It   usually  begins  with  slight  burning  on 
urination,  which  leads  the  subject  to  examine  his  penis, 
when  he  may  find  the  margins  of  the  urinary  opening 
red  and  somewhat  puffy.  Or  the  lips  of  the     e^n^ri- 
opening  may  be    stuck  together  when  he     4.Qjjig 
arises  in  the  morning,  and  a  drop  of  clear 
discharge,  like  white  of  ep;g^  can  be  expressed  from  it. 
The  symptoms  increase  rapidly,  and  within  another  day 
or  two  the  disease  is  at   its  height.    The  discharge  is 
then  more  profuse,  is  creamy  in  color  and  consistency, 
the  penis  is  sore,  and  urination  painful.  Erections  may 
be  frequent  and  painful,  especially  when  the  patient  is 
in  bed  and  when  the  inflammation  has  extended  out 
into  the  body  of  the  penis.    These  may  cause  intense 
pain,  and  the  organ  may  be  curved.    This  condition  is 
known   as  chordee.    The  inflammation  may  extend  to 
the  bladder,  causing  very  frequent  and  painful  urina- 
tion ;  to  the  testicles,  causing  swelling,  pain,  and  some- 
times abscess  formation,  and  often  leading  to  stoppage 
of  the  duct  leading  from  the  testicle  to   the   seminal 
bladder,  and  so  rendering  the  former  useless  as  a  pro- 
creative  organ.     Germs  may  be    carried   to  the  lym- 
phatic glands  in  the  groins,  and  cause  them  to  become 
very    painful,  tender,  and  swollen,  and  oftentimes  to 
sup])urate.  This  glandular  swelling  constitutes  a  bubo. 

These  various  troubles  may  cause  great  pain  and 
suffering,  but,  in  the  absence  of  further  complications, 
they  lessen  in  severity  after  a  time,  usually  from  one 
to  six  weeks,  the  swellings  subside,  the  discharge  dimin- 


288        THE  PREVENTION   OF  EPIDEMICS 

ishes  or  ceases,  and  the  patient  may  think  he  is  well. 

_       .   .         Or  he  may  recognize  that  he  has  gleet.  This 

is  a  condition  not  attended  by  other  symp- 

GI1C6  ./      X 

toms  than  the  presence  of  a  small,  clear  drop 
of  discharge  in  the  early  morning,  and  it  is  usually  re- 
garded as  of  no  importance.  It  is  gonorrhcea,  however, 
and  is  capable  of  setting  up  the  disease  in  others,  and 
many  unfortunate  brides  have  been  so  infected.  It  may 
persist  for  months  or  years,  and  other  manifestations 
of  the  disease  may  do  likewise.  Many  men  have  suffered 
or  died  from  the  results  of  gonorrhoea  ten,  twenty,  or 
more  years  after  they  thought  themselves  cured  of  it ; 
or,  worse  still,  they  have  seen  their  wives  or  children 
sicken,  become  blind,  or  die  as  the  result  of  it,  and  have 
had  no  thought  that  they  were  themselves  responsible 
for  the  calamity. 

The  complications  of  gonorrhoea  are  so  numerous,  so 
serious,  and  some  of  them  apparently  so  remote,  that 

there  is  no  space  to  discuss  them  here,  but 
.  some  of  them  will  be  mentioned.    Stricture 

is  one  of  the  most  common.  It  is  often  pre- 
sent when  a  gleet  persists.  It  may  cause  obstruction  of 
urine,  great  suffering,  and  serious  or  fatal  kidney  disease 
years  after  the  acute  gonorrhoea.  The  principal  symptom 
is  obstruction,  usually  partial,  to  the  urinary  stream.  In- 
Jlammation  of  the  itrostate  gland  may  develop  and  last 
for  years,  causing  pain  in  urination  and  perhaps  during 
defecation,  pain  deep  between  the  legs,  marked  nervous 
symptoms,  and  general  invalidism.  Gonorrlioeal  rheu- 
matisni,  or  joint  inflammation,  is  always  hard  to  treat, 
causes  great  pain,  and  tends  to  last  for  a  long  time.  It 
may  result  in  great  deformity  and  permanent  crippling. 
Tendon  inflammation  may  also  occur  and  produce  symp- 


VENEREAL   DISEASES  289 

toms  much  like  the  joint  troubles.  Pain  and  tenderness 
of  the  heel  or  of  the  great  tendon  leading  upward  from 
it  may  result  from  gonorrhcEa  and  prevent  marching. 
Eye  diseases  of  at  least  two  kinds  result  from  this  dis- 
ease and  always  endanger  and  frequently  destroy  the 
sight.  Gonorrhoea  is  one  of  the  great  causes  of  blind- 
ness, the  disease  often  developing  in  children  at  the 
time  of  birth,  from  infection  entering  their  eyes  from 
their  mother's  genitals,  the  mothers  often  being  infected 
by  their  husbands  who  thought  themselves  cured  before 
marriage.  The  disease  may  also  be  conveyed  to  the  eyes 
by  the  hands  after  urinating  or  wiping  away  discharge 
from  the  penis.  It  may  be  transferred  from  one  person 
to  another  through  the  medium  of  towels,  wash-cloths, 
medicine-droppers,  and  other  things  in  common  use. 
Blood-poisoning,  that  is,  the  diffusion  of  germs  through 
the  blood,  may  result  from  gonorrhoea  and  may  cause 
death.  Heart  disease  may  be  a  complication,  and  often 
accompanies  blood-poisoning.  It  may  cause  death  early 
or  may  be  apparently  recovered  from,  and  the  heart 
may  break  down  from  the  damage  done  it  only  after 
the  lapse  of  years.  Owing  to  the  levity  with  which  the 
disease  is  often  treated,  this  complication  may  not  be 
detected  at  the  time  of  its  occurrence. 

As   already  stated,  the   subject  of   gonorrhoea  is  a 
source  of  danger  to  his  companions  and  his  family,  and 
in  military  life  it  is  desirable  that  he  should 
be  confined  to  hospital,  at  least  during  the         ^ 
time  of  most  active  symptoms,  and  that  all 
men  should  be  cautioned  against  using  the  towels  or 
linen  belonging  to  others.    No  man  worthy  the  name 
would  deliberately  infect  another  person  with  his  dis- 
ease, but  many  men  unintentionally  do  so.    All  should 


290        THE   PREVENTION    OF   EPIDEMICS 

be  instructed  to  abstain  from  sexual  intercourse  until 
entirely  cured. 

Without  condoning  or  attempting  to  justify  illicit  in- 
tercourse, we  must  recognize  that  many  men  will  indulge 
in  it  in  spite  of  instruction,  warning,  and 
x^reve  -  example,  and  it  is  the  part  of  economy  and 
makes  for  the  efficiency  of  the  array  if  those 
men  can  be  protected  from  disease  in  spite  of  their  folly 
and  misconduct.  Nq  infallible  means  of  protection  from 
venereal  contamination  is  known  except  chastity,  but  the 
following  measures  may  offer  some  degree  of  it.  Urina- 
tion, if  practicable  immediately  after  intercourse,  tends 
to  wash  out  germs  that  may  have  entered  the  urethra. 
Irrigation  of  the  urethra  with  a  mild  antiseptic  solution, 
such  as  permanganate  of  "jDotash  solution  in  strength  of 
one  part  to  three  thousand,  has  a  similar  action.  Modera- 
tion in  intercourse  is  advisable.  Repeated  intercourse 
in  the  space  of  a  few  hours  brings  about  a  congestion 
of  the  genitals  which  is  slow  in  subsiding  and  which 
predisposes  to  infection.  Condoms,  impermeable  rub- 
ber coverings  for  the  penis,  are  sold  and  used  for  the 
prevention  of  disease,  and  tliey  should  protect  against 
gonorrhoea. 

After  the  disease  is  once  contracted  the  best  way  to 
prevent  complications  is  by  rest  in  bed  and  proper  treat- 
ment. Soldiers  should,  therefore,  be  taught 
,     ^     "      to  report  early  for  treatment,  and  to  con- 
^°         .        tinue  at  it  until  entirely  cured,  to  be  cleanly 
°  .  "  ^"      in  their  habits,  and  by  frequent  hand-wash- 
^  ins;  and  care  of  towels  and  linen  to  avoid 

infecting  the  eyes,  and  (very  important)  to  avoid  con- 
sultation with  advertising  quacks  or  the  use  of  adver- 
tised medicines,  both  of  which  are  fraudulent. 


VENEREAL  DISEASES  291 

Chancroid 

Chancroid,  soft  chancre  or  soft  sore,  is  the  least  im- 
portant of  the  diseases  here  discussed,  as  it  is  a  local  in- 
fection and  does  not  do  the  general  damage  or  assume 
the  manifold  and  insidious  forms  that  often  characterize 
gonorrhoea  or  sy})hilis. 

The  typical  and  usual  soft  chancre  is  due  to  a  small 
bacillus  which  bears  some  resemblance  to 
that  causing  plague,  but  ulcers  may  be  pro- 
duced on  the  penis,  as  elsewhere,  by  other  organisms. 

The  incubation  period  varies  from  one  to  ten  days, 
and  its  length  probably  depends  on  a  number  of  fac- 
tors, such  as  the  degree  of  infection  in  the 
woman,  the  presence  and  size- of  scratches 
or  abrasions  on  the  penis,  and  the  violence, 
length  and  frequency  of  the  infective  intercourse. 

The  disease  begins  as  a  small  ulcer,  or  sore,  which 
may  be  no  larger  than  the  head  of  a  pin.  The  favorite 
location  is  in  the  depression  or  groove  just 
back  of  the  head  of  the  penis,  though  it  ^  P 
may  be  anywhere  on  that  organ.  Many 
sores  may  show  at  once,  or  one  may  appear  at  first  and 
others  develop  later.  The  ulcer  enlarges  and  deepens, 
the  surrounding  parts  are  red,  swollen,  and  tender,  and 
the  surface  of  the  sore  more  so.  A  thin  and  usually 
moderate  discharge  is  present,  and  is  highly  infectious, 
and  its  presence  causes  the  development  of  the  sec- 
ondary sores.  Under  proper  treatment  the  ulcers  can 
usually  be  healed  in  a  few  days  or  weeks,  but  if  neg- 
lected or  improperly  ti'eated  or  in  inaccessible  positions, 
they  may  spread  and  produce  considerable  loss  of  tis- 
sue, half  or  more  of  the  head  of  the  penis  being  some- 


292        THE    PREVENTION   OF   EPIDEMICS 

times  destroyed.  The  base  of  the  ulcer,  if  not  irritated, 
is  usually  soft  as  compared  with  the  base  of  the  syphil- 
itic chancre,  hence  the  name  soft  chancre.  Occasion- 
ally this  sore  may  appear  on  the  bag,  on  the  lower 
hairy  part  of  the  abdomen,  or  anywhere,  in  fact,  that 
the  virus  has  entered  the  skin. 

p  ,.  The  most  frequent  complication  is  bubo, 

which  occurs  in  about  one  fourth  of  all  cases. 
It  is  very  painful,  causes  lameness,  fever, 
and  may  require  operation. 

The  methods  mentioned  as  tending  to  protect  from 
gonorrhoea  are  equally  applicable  here,  except  that 
_  irrigation  would  not  be  particularly  valu- 

.  able,  as  the  sore  usually   develops  exter- 

nally rather  than  in  the  urethra.  Washing 
the  genitals  in  an  antiseptic  solution,  such  as  one  to 
one  thousand  bichloride,  will  offer  a  certain  amount 
of  protection.  Early  and  proper  treatment  is  required 
to  produce  speedy  healing  and  lessen  the  tendency  to 
the  formation  of  buboes,  and  soldiers  should  report 
promptly  for  it. 

Syjjhills 

There  has  been  much  speculation  and  discussion  as 
to  whether  syphilis,  or  pock,  originated  in  the  old 
world  or  the  new,  whether  the  Spaniards  brought  it  to 
America,  or  took  it  from  here.  At  any  rate,  the  dis- 
ease spread  throughout  Europe  in  the  century  follow- 
ing Columbus's  voyages,  and  it  has  prevailed  through- 
out the  world  until  the  present  time,  and  is  now  seen 
in  all  ranks  of  society  and  all  walks  of  life.  It  is  the 
most  dreadful  of  the  diseases  considered  in  this  chap- 
ter because  of  its  chronicity,  the  long  time  required 


VENEREAL   DISEASES  293 

for  Its  treatment,  the  great  variety  of  its  manifestations, 
the  number  and  seriousness  of  the  conditions  resulting 
from  it,  and  the  fact  that  it  is  transmissible  by  hered- 
ity. The  disease  cannot  be  described  or  adequately 
discussed  in  the  space  allotted  here,  but  a  very  brief 
outline  of  it  will  be  given,  in  order  to  enable  the  line 
officer  to  impart  some  degree  of  information  about  it  to 
his  men. 

Although  the  disease  has  been  known  and  industri- 
ously studied  for  centuries,  it  is  only  lately 
that  its  cause  has  been  known.  This  is  the 
very  fine  and  delicate  spiral  organism  mentioned  in  a 
preceding  chapter  as  a  treponema. 

The  commonest  method  of  transmission  of  syphilis  is 
through  sexual  intercourse,  and  this  is  especially  true 
as  regards  soldiers,  to  whom  many  of  the 
other  avenues  of  infection   are   not  open. 
But  there  are  such  other  avenues  and  they 
are  numerous ;    and   innocent  victims   of  this  disease 
are  therefore  more  numerous  than  those  of  gonorrhoea 
or  chancroid.    Among  such  methods  we  may  mention 
the  following :  — 

Heredity.  The  disease  may  be  inherited  from  either 
parent,  and  may  infect  the  child  in  the  womb  and  cause 
its  death  there,  cause  it  to  be  born  diseased,  or  to  be 
born  apparently  well  and  develop  the  disease  soon  after. 
Or,  in  rare  cases,  it  may  be  born  apparently  well  and 
continue  fairly  so  for  years,  and  only  show  the  disease  in 
recognized  form  when  it  reaches  the  age  of  puberty. 

Contact^  especially  such  as  kissing,  is  a  fairly  common 
method  of  transmission.  Ulcers  or  sores  in  the  mouth 
are  a  common  manifestation  of  the  disease,  and  in  such 
cases  the  organisms  are  present  and  sometimes  numer- 


294       THE   PREVENTION   OF   EPIDEMICS 

ous  there.  The  saliva  or  discharge  from  such  a  mouth 
is  highly  infectious,  and,  if  brought  in  contact  with  a 
slight  scratch  or  sore,  will  give  rise  to  the  disease.  Chil- 
dren and  girls  have  many  times  been  infected  by  kissing 
persons  so  affected,  and  syphilitic  children  may  by  this 
means  infect  the  nipples  of  their  wet  nurses.  For  this 
reason,  also,  the  sjioons,  cups,  and  other  eating  uten- 
sils and  pipes  or  cigarette-butts  that  have  been  used  by 
syphilitics,  are  dangerous.  The  blood  and  discharges 
from  sores  on  syphilitic  persons  are  infectious,  and 
nurses  and  doctors  are  occasionally  infected  in  dress- 
ing or  operating  upon  such  cases.  Several  instances 
of  the  kind  have  occurred  in  the  army.  Barbers  may 
receive  infection  if  they  get  wounds  or  scratches  con- 
taminated by  the  saliva  or  blood  of  their  patrons, 
and  they  may  also  transmit  it  through  scratches  or 
cuts.  Dentists  and  their  implements,  if  not  clean,  may 
transmit  it. 

The  incubation  period  of  syphilis  is  long.  It  is  never 
less  than  ten  days,  and  it  is  said  that  it  may  be  as  long 
as  ninety.   As  a  rule,  however,  it  is  from 
three  weeks  to  one  month,  after  which  time 
the  primary  sore  or  chancre  develops  at  the 
point  of  entrance  of  the  virus.     This  fact  may  be  of 
value  in  determining  the  manner  of  infection.    If  the 
chancre  be  on  the  genitals,  it  is  usually  a  result  of  sex- 
ual intercourse ;  if  elsewhere,  the  case  may  be  different. 
It  may  be  on  any  part  of  the  body,  as  on  the  top  of  the 
head  or  the  ear,  where  it  has  been  seen  to  result  from 
bites  received  in  fighting;  inside  the  rectum  as  a  result 
of  unnatural  practices  :  on  the  breast  of  a  wet  nurse  ; 
or  on  the  arm  of  a  child  vaccinated  with  virus  from  a 
syphilitic. 


VENEREAL  DISEASES  295 

The  chancre  constitutes  the  first  sign  of  the  disease. 
It  appears  first  as  a  small  firm  lump  resembling  a  pimple. 
This   may  enlarge  considerably  or  not  at 
all,  dejjending  somewhat  on  its  situation.  ^ 

It  usually  ulcerates  slightly  at  its  top,  and  ° 

shows  a  slight  discharge,  which  may  be  thin  and  clear, 
or  purulent.  The  chancre  is  nearly  always  single,  and 
secondary  ones  rarely  develop.  Its  base  is  usually  hard 
and  firm  and  feels  like  cartilage  or  even  like  bone,  hence 
this  is  called  the  hard  chancre.  It  may  be  so  small  as 
not  to  be  noticed,  and,  as  the  patient  may  continue  feel- 
ing well  while  he  has  it,  he  may  not  know  that  he  is 
diseased  until  the  appearance  of  secondary  symptoms 
after  another  period  of  six  to  twelve  weeks.  It  is  not 
rare  to  have  soldiers  appear  with  well- 
marked  secondary  signs  of  the  disease  and 
no  chancre,  and  denying  that  they  have  had  «*. 
any.  The  secondary  symptoms  are  usually 
plainly  marked  and  lead  the  patient  to  seek  treatment. 
They  are  referred  particularly  to  the  skin  and  mucous 
membranes,  and  the  most  common  of  them  are  skin  erup- 
tions, sores  in  the  mouth  and  throat  and  about  the  anus, 
falling  of  hair,  slight  fever,  pains  in  the  bones  or  joints, 
anaemia,  and  pallor,  and  various  eye  troubles.  The  skin 
lesions  of  syphilis  are  so  numerous  and  of  such  varied 
character  that  it  has  been  said  that  they  can  simulate 
all  other  skin  diseases.  The  arteries,  heart,  and  internal 
organs  may  also  be  affected  in  the  secondary  stage.  In 
fact,  no  other  known  disease  manifests  itself  in  so  many 
ways  as  this  one,  and  it  simulates  the  gi-eatest  variety 
of  affections,  including  smallpox  and  other  eruptive 
diseases,  malaria,  liver  abscess,  tuberculosis  of  lungs, 
bones,  or  joints,  epilepsy,  and  very  many  more.  It  is, 


296       THE  PREVENTION   OF   EPIDEMICS 

therefore,  obviously  out  of  the  question  even  to  mention 
most  of  the  symptoms  here. 

This  stage  may  not  manifest  itself  if  the  case  is  well 
treated  in  the  primary  and  secondary  stages.    Other- 
wise it  may  mereje  with  the  secondary,  or  it 
^     may  appear  only  after  the  lapse  of  years. 
°  It  is  characterized  by  deeper  skin  lesions, 

that  show  a  tendency  to  ulcerate  and  form  large  and 
deep  sores,  by  destruction  of  bone,  the  formation  of 
swellings  or  tumors,  and  the  degeneration  of  internal 
organs.  Tertiary  syphilis  is  more  often  mistaken  for 
tuberculosis,  cancer,  and  other  chronic  ailments,  than 
for  more  acute  ones.  The  syphilitic  tumors  may  form 
in  any  part  of  the  body,  and  those  in  the  brain, 
heart,  spinal  cord,  and  other  vital  parts  may  be  rapidly 
fatal.    Syphilis  is  the  most  common  cause  of  aneurism. 

The  disease  is  usually  spoken  of  as  consisting  of 
three  stages,  but  some  writers  consider  a  group  of  se- 
_         ,  vere  and  incurable  nervous  troubles,  espe- 

_  cially  locomotor  ataxia  and  general  paraly- 

sis  of  the  insane,  to  constitute  a  so-called 
fourth  stage.  Whether  or  not  this  is  true  cannot  be 
positively  stated  ;  but  syphilis  undoubtedly  exercises 
a  strong  predisposing  influence  in  regard  to  those  dis- 
eases. 

Syphilis  is  transmissible  in  any  of  its  stages ;  highly 

so  in  the  first,  more  so  in  the  second,  and 

Period        ^^^   slightly  in  the   third.     The   time    of 

greatest  danger  is  that  during  which  there 
t^cious-  .  .  . 

are  sores,  with  open  moist  surfaces,  in  the 
Hess 

mouth,  the  nose,  on  the  genitals,  and  about 

the  anus;  and  it  is  advisable,  in  military  service, to  con- 
fine in  hospital  men  who  pi'esent  such  lesions.  At  other 


VENEEEAL  DISEASES  297 

times  if  they  are  kept  under  observation  by  a  medical 
officer  and  continue  their  treatment,  they  may  safely 
mingle  with  their  fellows  and  do  full  duty. 

There  is  some  difference  of  opinion  as  to  the  length 
of  time  required  to  effect  a  cure  of  syphilis,  some  au- 
thorities giving  two  years  as  the  minimum 
period,  and  others  saying  that  at  least  four  ° 

are  required.  It  is  probable  that  two  years 
of  faithful  and  proper  treatment  will  suf- 
fice to  cure  the  majority  of  cases  of  syphilis,  but  a 
small  minority  require  all  of  four  years  or  more.  This 
cannot  be  too  strongly  impressed  on  aU  syphilitics, 
and  their  own  welfare  and  that  of  their  families  de- 
mands that  they  should  take  proper  and  continued 
treatment  under  the  supervision  of  a  competent  physi- 
cian for  at  least  two  years,  and  longer  if  the  physician 
advises  it.  No  syphilitic  should  marry  until  under  ob- 
servation and  treatment  for  at  least  two  yesiTs/rom  the 
last  appearance  of  symptoms. 

The  special  preventive  measures  that  may  be  em- 
ployed by  men  exposing  themselves  to  the  dangers  of 
polluted  intercourse  are  the  same  as  were 
mentioned  for  gonorrhoea  and  chancroid.  A 
small  amount  of  experimental  and  clinical      ^ 
evidence  also  indicates  that  protection  may  be  conferred, 
in  at  least  some  instances,  by  the  use  of  a  calomel 
ointment.  This  is  thirty  per  cent  calomel  in  lanolin,  and 
should  be  well  rubbed  into  the  penis  and  exposed  parts 
for  from  five  to  twenty  minutes,  at  the  conclusion  of 
the  intercourse  and  after  the  use  of  the  irrijration  and 
wash  mentioned  as  preventive  of  gonorrhoea  and  chan- 
croid. 


298        THE  PREVENTION  OF  EPIDEMICS 

Mixed  Infections 

One  may  be  simultaneously  infected  with  two  or  all 
of  the  venereal  diseases,  and  in  such  instances  the  more 
quickly  developing  gonorrhcea  or  chancroid  masks  the 
presence  of  the  chancre,  and  great  surprise  may  result 
when  the  secondary  symptoms  of  syphilis  become  mani- 
fest. Occasionally  the  chancre  develops  inside  the 
urethra  and  occasions  a  slight  discharge  which  may  be 
mistaken  for  gonorrhoea,  or  the  latter  disease  may  co- 
exist. In  either  event  the  chancre  may  be  overlooked. 
More  frequently,  however,  the  confusion  arises  from 
the  coexistence  of  soft  and  hard  chancres.  It  is  gener- 
ally believed  by  men  having  venereal  sores  that  the  soft 
sore  is  never  syphilitic,  and  that  it  always  arises  within 
ten  days,  while  the  hard  chancre  is  always  syphilitic, 
and  never  appears  within  ten  days.  These  are  usually 
true  as  related  to  pure  single  infections.  But  the  viruses 
of  soft  chancre  and  of  syphilis  may  both  enter  the  skin 
at  the  same  point,  in  which  case  a  soft  and  ulcerating 
sore  may  develop  early  and  be  followed  by  a  large 
suppurating  bubo,  a  thing  not  occurring  in  pure  syph- 
ilis, and  may  heal  under  local  treatment,  leaving  no 
induration,  or  only  a  slight  one  that  is  ascribed  to  inflam- 
mation. The  syphilitic  virus  nevertheless  continues  its 
work  and  in  due  time  the  secondary  symptoms  develop. 
Some  soft  sores,  especially  those  burned  with  acids,  have 
a  base  of  inflammatory  tissue  that  may  greatly  resemble 
the  hard  base  of  the  syphilitic  sore. 

So  difficult  is  the  differentiation  of  syphilitic  from 
non-syphilitic  venereal  sores,  by  the  appearance  alone, 
that  most  careful  practitioners  do  not  definitely  decide 
that  a  given  sore  is  syphilitic,  and  therefore  do  not 


VENEREAL  DISEASES  299 

begin  constitutional  treatment  until  secondary  symptoms 
occur.  Laboratory  methods  now  permit  of  positive  early 
diagnosis  in  a  considerable  number  of  cases. 

In  some  cases  of  syphilis  the  secondary  stage  is  very 
lightly  marked,  and  may  be  overlooked,  so  that  men  are 
occasionally  seen  suffering  with  tertiary  lesions,  and 
stoutly  and  in  good  faith  denying  that  they  ever  had 
either  a  hard  chancre  or  secondary  symptoms. 


INDEX 


Abdomen,  the,  6. 

Abstinence,  total,  encouragement 
of,  28. 

Accidents,  condition  of  mouth  in, 
25. 

Acid,  boric,  as  food  preservative,  39. 

Acid,  carbolic,  as  antiseptic,  210;  as 
vermin  killer,  72;  use  of,  in  flush 
closets,  63;  for  camp  urinals,  98 

Acids,  organic,  food-value  of,  35, 
122. 

Actinomycosis,  transmission  of,  37. 

Age,  as  a  factor  in  efficiency  of  the 
recruit,  4;  diseases  and,  143. 

Age  limit  of  recruits,  3. 

"  Ague-fit,"  171. 

Air,  arctic,  131;  as  predisposing  fac- 
tor in  disease,  149 ;  effect  of,  on  epi- 
demics, 242;  fresh,  value  of,  20; 
moist,  supply  of,  in  rooms,  69. 

Air-space,  quantity  of,  per  man,  56. 

Albuminuria,  due  to  faulty  diet,  34. 

Alcohol,  28,  31,  151 ;  on  marches,  106; 
use  of,  in  arctics,  133;  use  of,  in 
tropics,  123. 

Alcoholism,  indicated  by  condition 
of  nose,  9. 

Alkalies,  as  cause  of  disease,  160. 

Ambulance  kitchens,  110. 

Amoeba,  as  cause  of  liver  abscess, 
172. 

Anemia,  influence  of  neglected 
mouth  on,  25. 

Animal  poisons,  162. 

Animals,  disinfection  of,  254. 

Anopheles,  carriers  of  malaria,  72, 
200,  265. 

Anthrax,  transmission  of,  37,  191. 

Antiseptics,  210;  action  of,  178. 

Antitoxin,  as  specific  for  diphtheria, 
212,  255;  as  specific  for  tetanus, 
212. 

Anus,  cause  of  irritation  of,  64. 

Appearances,  as  guide  to  judgment 
of  characters,  18. 


Appetite,  effect  of  cooking  on  the, 
39. 

Aprons,  liberal  use  of,  by  company 
barber,  61. 

Arch  of  foot,  deformities  of,  15. 

Arms,  of  recruit,  12. 

Assimilation,  increase  of,  by  exer- 
cise, 21. 

Asthma  and  barrel-shaped  chest,  6. 

Athletes,  effect  of  oxygen  on,  104. 

Athletics,  encouragement  of,  21. 

Atmosphere,  state  of,  as  affecting 
epidemic,  241. 

Auger,  post-hole,  for  digging  la- 
trines, 96. 

Auto-intoxication,  161. 

Bacilli,  definition,  176. 

Bacillus,  anthrax,  resistance  of 
spores  of,  176. 

Bacillus  prodigiosus,  harm  of,  in  ery- 
sipelas, 179. 

Bacteria,  174;  action  of  sunlight  on, 
178;  aerobic,  176;  anaerobic,  176; 
dried,  harm  of,  178;  mutual  de- 
struction of,  178;  reproduction  of, 
176;  transmission  of,  37. 

Baking-ovens,  field,  87. 

Baldness  of  recruit,  12. 

Barber,  company,  61. 

"  Barrack  odor,"  avoidance  of,  21. 

Barracks,  hygiene  of,  54. 

Barrels,  as  night  urinals,  98. 

Barrels,  use  of  for  drinking  water, 
81. 

Bathing,  by  roster  if  necessary,  62; 
in  causes  of  disease,  152 ;  in  camp, 
83. 

Bath-rooms,  62. 

Baths,  23,  127. 

Bath-tubs,  67. 

Batter-cakes,  41. 

Battlefield,  hygiene  of,  115. 

Bay  rum,  use  of  by  drunkards,  29. 

Beans,  24;  cooking  of,  in  field,  87. 


302 


INDEX 


Bedbugs,  22,117,252,280;  as  disease- 
carriers,  193. 

Bedding,  airing  of,  23;  improvised, 
for  camps,  78. 

Bed-nets,  necessity  of,  57,  271. 

Beef,  standard  component  of  meat 
ration,  35. 

Beets,  42. 

Belly-band,  124. 

Belly,  first  aid  to  wounds  of,  116. 

Beverages,  47. 

Bichloride,  for  camp  urinals,  98. 

Birds,  as  carriers  of  tuberculosis, 
190. 

Bitter  Root  Valley,  fever  in,  74. 

Bivouac,  bedding  for,  78 ;  menace  of, 
to  inhabitants,  77. 

Bill  of  fare,  weekly,  48-50. 

Binder,  abdominal,  124. 

Biscuits,  baking  of,  by  company 
cooks,  40. 

Bladder,  cause  of  irritation  of,  107. 

Blankets,  frequent  airing  of,  in 
camps,  77;  when  to  be  carried,  111. 

Bleeders,  143. 

Blindness,  due  to  wood  alcohol,  29. 

Blood,  in  causes  of  epidemics,  244; 
in  feces,  surgeon  to  be  consulted, 
64 ;  vomiting  of,  cause  for  rejecting 
recruit,  8. 

Blood-poisoning,  gonorrhoeal,  289. 

Blouses,  impediment  of,  in  tropics, 
111. 

Blow-flies,  169. 

Board,  anti-typhoid,  237. 

Board  floors,  provision  of,  in  camp, 
78. 

Body,  types  of,  143. 

Body-vermin,  spread  of,  in  camps, 
78. 

Boils,  preventive  measures  for,  128. 

Bone,  deformities  of,  6. 

Books,  as  disease-carriers,  194. 

Bottoms,  river,  diseases  of,  74. 

Bowels,  regulation  of,  24.' 

Bow-legs,  13. 

Bowls,  lavatory,  as  receptacle  for 
improper  objects,  65, 67. 

Bread,  40. 

Breeding-places,  mosquito,  destruc- 
tion of,  266. 

Breast-bone,  depression  of,  6;  promi- 
nence of,  6. 


Bright's  disease,  relation  of  weights 
to  deaths  from,  5. 

Buboes,  16,  287,  292;  cases  of,  on 
marches,  105. 

Buildings,  54. 

Bunion,  14. 

Butter,  45;  as  carrier  of  tubercu- 
losis, 189. 

Buttermilk,  45. 

Cabins,  as  substitutes  for  tents,  79. 

Caisson-disease,  158. 

Cake,  40. 

Camp  craft,  development  of,  87. 

Camp  police,  99. 

Camps,  and  camp  life,  73. 

Camp-sites,  as  factor  in  causes  of 
disease,  154;  in  prevention  of  epi- 
demics, 233. 

Cancer,  as  effect  of  tobacco,  30 ;  re- 
lation of  weights  to  deaths  from,  5. 

Canning,  comparative  value  of,  for 
food  preservation,  39. 

Cans,  as  night  urinals,  98;  garbage, 
care  of,  52, 61, 88 ;  tin,  disposal  of,  in 
camps  89;  use  of,  for  cooling 
drinking  water,  81. 

Carbohydrates,  34, 122. 

Carbon,  monoxide,  given  off  by  cast- 
iron  stoves,  69. 

Carpets,  as  disease-carriers,  194. 

Carriers,  chronic,  of  typhoid,  216. 

Carriers,  disease,  animal,  184;  hu- 
man, 180;  inanimate,  193;  insect, 
192;  of  anthrax,  191;  of  cerebro- 
spinal meningitis,  181;  of  dysen- 
tery, 182,  213 ;  of  glanders  or  farcy, 
186;  of  gonorrhcea,  183;  of  gonor- 
rhoea of  eye,  182;  of  hydrophobia, 
184 ;  of  impetigo,  182 ;  of  intestinal 
worms,  182 ;  of  itch,  182 ;  of  plague, 
187;  of  pneumonia,  181;  of  ring- 
worm, 182 ;  of  scarlet  fever,  181 ;  of 
smallpox,  183;  of  syphilis,  183;  of 
tonsillitis,  182;  of  trachoma,  182; 
of  tuberculosis,  182, 189 ;  of  typhoid 
fever,  182,  213. 

Carriers,  of  water-borne  diseases, 
213. 

Casualties,  relation  of  weights  to 
deaths  from,  5. 

Caterpillars,  as  cau.se  of  disease,  158. 

Cats,  as  carriers  of  diphtheria,  191 ; 


INDEX 


303 


as  carriers  of  hydrophobia,  184;  as 
carriers  of  tuberculosis,  190 ;  exclu- 
.sion  of,  from  camps,  78;  not  to  be 
allowed  in  kitchen,  61. 

Cattle,  as  carriers  of  tuberculosis, 
189. 

Cavalry,  most  desirable  recruits  as 
to  size  for,  4, 

Cellars,  damp,  avoidance  of,  55. 

Cellular  tissue,  diseases  of,  relation 
of  weights  to  deaths  from,  5. 

Cellulose,  34. 

Cereals,  underdone,  as  cause  of  indi- 
gestion, 87. 

Cerebral  aflEections,  relation  of 
weights  to  deaths  from,  5. 

Cerebro-spinal  meningitis,  transmis- 
sion of,  181. 

Chafing,  preventive  measure  for,  128. 

Chancroid,  291. 

Character,  of  recniits,  18. 

Cheerfulness,  as  stimulant,  106. 

Cheese,  as  carrier  of  tuberculosis, 
189. 

Cheese,  Roquefort,  moulds  of,  174. 

Cheeses,  45. 

Chemicals,  as  cause  of  death  or  dis- 
ease, 158 ;  as  meat  preservative,  39 ; 
bactericidal  action  of,  178. 

Chest,  asymmetry  of,  6;  barrel- 
shaped,  6 ;  certain  types  of,  indica- 
tive of  disease,  6;  freedom  of,  on 
marches,  104;  long,  narrow,  pre- 
disposing to  consumption,  6;  mea- 
surement and  weight,  publication 
of  proportions  of,  4;  mobility  of, 
5,  6. 

Chicken-pox,  incubation  period  of, 
247. 

Chiggers,  170. 

Childhood,  diseases  of,  240. 

Chlorine,  as  disinfectant,  208. 

Cholera,  isolation  of,  229 ;  prevalence 
of,  121 ;  prevention  of,  in  camp,  80, 
108;  toxin  in,  179;  transmission  of, 
127,  182,  193,  213;  vaccination 
against,  236, 

Chordee,  287. 

Cigarette-smoking,  30. 

Cigar-smoking,  30. 

Circulatory  system,  relation  of 
weights  to  deaths  from  diseases  of 
the,  5. 


Cirrhosis,  of  liver,  relation  of 
weights  to  deaths  from,  5. 

Cleanliness,  a  primary  rule  for  cooks, 
51,61;  as  preventative  of  epidem- 
ics, 232,  250;  habits  as  to,  revealed 
by  linen  worn,  17;  in  tropics,  129; 
personal,  22. 

Climate,  demands  of  as  to  clothing, 
30,  152;  influencing  marches,  101. 

Climates,  120;  arctic,  131;  cold,  diet 
in,  34. 

Clothing,  adjustment  of,  to  variable 
needs,  30,  111,  124,  152;  allowance 
in  field  kit,  112;  as  block  to  actin- 
ism, 125;  changing  of,  23;  dirty,  to 
be  excluded  from  squad-rooms, 
58;  disinfection  of,  254;  facilities 
for  washing  in  camp,  86 ;  for  arc- 
tics, 134;  in  causes  of  disease,  152, 
193;  quality  of,  as  issued,  24 ;  ver- 
min-infested, 72. 

Clubfoot,  13. 

Coast  artillery  corps,  most  desirable 
recruits  as  to  size  for,  4. 

Coats,  impediment  in  tropics.  111. 

Cocci,  definition  of,  176. 

Cocoa,  47. 

Coffee,  47 ;  drinking  of,  on  the  march, 
109. 

Cold,  as  meat  preservative,  38. 

"  Colds,"  cause  of,  20. 

Cold  storage,  use  of,  to  preserve 
foods,  46. 

Colic,  gallstone,  as  cause  of  rejection 
of  recruit,  8. 

Comma-bacillus,  214. 

Company  mess,  influence  of,  24,  50. 

Components,  substitutes  of  meat  ra- 
tion, 35 

Condiments,  food- value  of,  35;  use 
of,  in  tropics,  123. 

Constipation,  causes  of,  45. 

Consumption,  and  type  of  chest,  6. 

Contact,  as  cause  of  epidemic  dis- 
ease, 224,  243. 

Containers,  food,  handling  of, 
against  vermin,  88. 

Contamination,  fecal,  in  field,  88. 

Continence,  sexual,  27. 

Cook,  as  model  of  cleanliness,  61,  68. 

Cookers,  fireless,  87,  110. 

Cooking,  aspect  of,  in  field,  86;  field 
facilities  for,  87 ;  on  transports,  117. 


304 


INDEX 


Cooks,  company,  common  faults  of, 
39 ;  importance  of,  50. 

Corn,  42. 

Cornbread,  41. 

Corns,  14. 

Cots,  for  permanent  camps,  78. 

Cough,  in  recruit,  10 ;  tobacco,  29. 

Crab-lice,  presence  of,  16. 

Cream,  as  carrier  of  tuberculosis, 
189. 

Cremation,  as  preventative  against 
epidemics,  233. 

Crematory,  improvised,  91. 

Creolin,  as  germicide,  211. 

Crowding,  influence  of,  on  epidem- 
ics, 241. 

Culex  fatigans,  carrier  of  dengue 
and  filariasis,  264. 

Cuspidors,  for  day-rooms,  59. 

Darnall's  filter,  value  of,  in  camp,  81. 

Day-rooms,  58. 

Day  urinal,  for  camps,  98. 

Deaths,  from  typhoid,  219. 

Deer,  as  carriers  of  anthrax,  191. 

Defecation,  danger  in,  26. 

Defects,  if  noted  by  recruit's  C.  O. 
to  be  referred  to  medical  oflBcer, 
19. 

Dengue,  173,  264;  isolation  of,  205; 
protection  against,  111,  129. 

Dentists,  scarcity  of,  25;  to  be 
promptly  consulted,  26. 

Deodorants,  use  of,  64. 

Deodorization,  208. 

Desserts,  43. 

Dhobie  itch,  preventive  measures 
for,  128. 

Diabetes,  relation  of  weights  to 
deaths  from,  5. 

Diagnosis,  early,  in  control  of  epi- 
demics, 252;  in  prevention  of  epi- 
demics, 228. 

Diarrhoea,  camp,  76, 110,  213;  due  to 
faulty  diet,  34. 

Digestion,  increased  by  exercise,  21. 

Digestive  system,  diseases  of  the,  re- 
lation of  weights  to  deaths  from,  5. 

Dining-room,  59. 

Diphtheria,  181;  antitoxin  In,  255; 
incubation  period  of,  247 ;  toxin  in, 
179;  transmission  of,  26,  44,  191, 
193,  251. 


Diplocoeci,  176. 

Discharges,  disinfection  of,  254. 

Disease,  carried  by  water-supply,  26, 
213;  cause  of,  by  leaky  plumbing, 
67;  echinococcus,  132;  effect  of 
mental  state  on,  145;  epidemic, 
compulsory  registration  of,  230, 
277;  epidemic,  investigation  of 
cases  of,  231 ;  epidemic,  tracing  of, 
253;  general  defense  against,  199; 
of  Japanese  river-bottoms,  75; 
prevention  of,  by  medical  depart- 
ment, 73;  schistosomum,  152,  162; 
transmission  of,  by. toilet  articles, 
22 ;  vermin  as  carriers  of,  22 ;  wool- 
sorters',  191. 

Disease-carriers,  180,  213.  See,  also, 
Carriers,  disease. 

Disease-centres,  selection  of  camp- 
sites in,  76. 

Disease-transmission,  prevention  of, 
180. 

Diseases,  air-borne,  239,  240;  borne 
by  bedbugs,  280;  "catching,"  iso- 
lation of,  205 ;  causes  of,  139 ;  con- 
tagious, 239;  debilitating,  recur- 
rence of,  105;  exciting  causes  of, 
156;  flea-borne,  273 ;  fly-borne,  278 ; 
formites-borne,  239;  general,  in- 
dication, of,  10;  infectious,  in 
company  cook,  51;  influence  of 
condition  of  mouth  on,  25;  inher- 
ited, 141;  insect-borne,  76,  129,  257; 
intestinal,  prevention  of,  87;  intes- 
tinal, due  to  vegetables,  122;  mos- 
quito-borne, 257;  skin,  in  men  or 
company  barber,  62 ;  table  of  death 
rates  of,  as  influenced  by  weight, 
4,5;  tick-borne,  279;  tropical,  na- 
ture of,  125;  venereal,  281;  vene- 
real, during  marches,  105;  vene- 
real, measures  against,  284;  water- 
borne,  213. 

Dishes,  as  carriers  of  water-borne 
diseases,  222. 

Disinfection,  206,  254;  against  epi- 
demics, 232,  254. 

Dogs,  as  carriers  of  diphtheria,  191 ; 
as  carriers  of  hydrophobia,  184;  as 
carriers  of  tuberculosis,  190;  ex- 
clusion of,  from  camps,  78 ;  not  to 
be  allowed  in  kitchen,  61. 

Doors,  storm,  57. 


INDEX 


305 


Drain  openings,  clogging  of,  to  be 
prevented,  G2. 

Drainage,  town,  danger  of,  to  water- 
supply,  83. 

Dress,  discretion  in,  30. 

Drills,  as  aid  to  change  of  air  in 
lungs,  20. 

Drugs,  as  food  preservatives,  39. 

Drj'-earth  system,  in  disposal  of  ex- 
creta, 97. 

Drying,  for  preserving  of  food,  46. 

Dugouts,  as  substitutes  for  tents,  79. 

Dust,  as  disease-carrier,  222. 

Dysentery,  amoebic,  172;  causes  of, 
214;  isolation  of,  229;  occurrence 
of,  76;  prevalence  of,  121;  preven- 
tion of,  in  camp,  80, 108 ;  recurrence 
of,  on  marches,  105;  transmission 
of,  182,  193,  213;  use  of  alcohol  in, 
12-t;  vaccination  against,  236. 

Dyspepsia,  causes  of,  34,  47. 

Ears,  examination  of,  9. 

Eating,  as  cause  of  exhaustion,  107; 
leisurely,  GO ;  proper  manner  of,  to 
be  taught  to  soldier,  24. 

Echinococcus,  132. 

Economy,  in  use  of  water,  65 ;  mea- 
sures of,  in  company  mess,  41. 

Effects,  personal,  disinfection  of, 
254. 

Eggs,  36. 

Electricity,  as  cause  of  disease,  158. 

Emissions,  seminal,  27. 

Emphysema,  and  barrel-shaped 
chest,  6. 

Emunctories,  activity  of,  21. 

Endurance,  increase  of,  by  oxygen, 
104. 

Engineering,  works  of,  against  epi- 
demics, 206. 

Environment,  affecting  disease,  148. 

Epidemics,  control  and  prevention 
of,  197,  250;  danger  of,  73;  general 
measures  against,  232,  250;  meth- 
ods of  transmission,  241;  origin 
of,  215. 

Epilepsy,  indications  of,  11. 

Epizootic,  transmission  of,  188. 

Erysipelas,  bacterial  action  in,  179. 

Excitement,  sexual,  periods  of,  27. 

Excreta,  disposal  of,  on  the  march, 
114. 


Exercise,  21 ;  in  tropics,  126. 

Exhaustion,  due  to  water,  107;  pre- 
disposed by  alcohol,  106. 

Exposure,  effect  of,  on  disease, 
147. 

Extracts,  flavoring,  use  of,  by  drink- 
ers, 29. 

Eyes,  affections  of,  transmitted  by 
toilet  articles,  22 ;  examination  of, 
8;  gonorrhceal  infection  of,  289. 

Farcy,  transmission  of,  186. 

Fare,  bills  of,  advance  preparation 
of,  40. 

Fatigue  parties,  under  medical  offi- 
cer, 99. 

Fats,  34, 122. 

Feces,  disposal  of,  to  prevent  epi- 
demics, 233;  habitual  inspection 
of,  64;  human,  as  field  manure, 
236;  human,  disposal  of,  in  camp, 
91. 

Feet,  care  of,  23,  31,  112;  of  recruit, 
12 ;  soiled,  as  carriers  of  epidemics, 
226;  stinking,  14;  sweating,  14; 
weak,  men  with,  excluded  from 
marches,  105. 

Fever,  Malta,  transmission  of,  44 ;  re- 
lapsing, transmission  of,  75,  193, 
279;  scarlet,  incubation  period  of, 
247;  scarlet,  isolation  of,  205;  scar- 
let, transmission  of,  44, 181. 191,  193 ; 
Texas,  193 ;  tick,  of  Montana,  74, 193, 
279;  yellow,  173,  192,  260;  yellow, 
protection  against.  111. 

Filaria,  168,  192. 

Filariasis,  261. 

Filter,  Darnall's,  use  of,  in  camp, 
81. 

Filters,  Berkfeld,  81. 

Fingers,  deformities  of,  12;  loss  of, 
12. 

Fire  buckets,  as  mosquito  breeders, 
71. 

Fire,  kitchen,  as  crematory,  89 ;  pro- 
tective measures  against,  71. 

Fires,  open,  as  aid  to  ventilation, 
68. 

First-aid  packets,  116. 

Fish,  36;  as  carriers  of  tuberculosis, 
190;  use  of,  in  exterminating  mos- 
quitoes, 268. 

Flannels,  use  of,  in  tropics,  125. 


306 


INDEX 


Flat  foot,  15. 

Flavors,  food-value  of,  35. 

Flea,  of  rat,  history  of,  274. 

Flea-bites,  as  cause  of  plague,  126, 
188,  192,  273. 

Fleas,  as  carriers  of  typhus,  252 ;  as 
disease-carriers,  193;  in  camp,  79; 
measures  against,  to  prevent 
plague,  277 ;  transmission  of,  by  do- 
mestic animals,  191. 

Flies,  as  carriers  of  general  diseases, 
193 ;  as  cause  of  epidemics,  223;  as 
transmitters  of  sleeping  sickness, 
75,  173;  breeding  of,  in  waste,  91, 
224 ;  prevention  of,  in  camp,  79,  88 ; 
prevention  of,  in  excreta  trenches, 
94;  protection  from,  59;  protection 
from,  in  kitchen,  52;  protection 
from,  to  prevent  epidemics,  233. 

Floor-room,  minimum  quantity  for 
each  man,  56. 

Flukes,  162. 

Fomites,  227,  242. 

Food,  and  its  supply  during  epi- 
demics, 251 ;  as  carrier  of  disease, 
193;  cooked,  value  of,  in  held,  87; 
cooking  of,  during  epidemics,  23G; 
exclusion  of,  from  tents,  77 ;  facili- 
ties for  storing  in  field,  88 ;  in  arc- 
tics, 133;  in  hot  countries,  121;  on 
transports,  117;  supply  of,  on  the 
march,  109. 

Food-receptacles,  washing  of,  in 
camps,  83. 

Foods,  etc.,  33, 151;  absence  of,  from 
squad-rooms,  58 ;  canned,  46;  odor- 
ous, not  to  be  kept  in  ice  chest,  52 ; 
raw,  washing  of,  before  eating,  83, 
236. 

Forbes-Waterhouse  sterilizer,  81. 

Formaldehyde,  as  disinfectant,  208. 

Formalin,  as  disinfectant,  209,  211; 
for  camp  urinals,  98 ;  as  food  pre- 
servative, 39. 

Fowl,  36. 

Fox,  as  carrier  of  hydrophobia,  184. 

Freezing,  131,  136;  predisposed  by 
alcohol,  106. 

Frost-bite,  131,  136. 

Fruits,  dried,  47;  unripe,  interdic- 
tion of,  87;  use  of,  in  tropics,  122. 

Fumigation,  208. 

Furnaces,  hot-air,  69. 


Gallstone,  colic  due  to,  as  cause  for 

rejection  of  recruit,  8. 
Games,  encouragement  of,  21. 
Gangrene,  local,  influenced  by  neg- 
lected mouth,  25. 
Garbage,  disposal  of,  in  camp,  89. 
Garbage-cans,  care  of,  52,  61,  88. 
Gases,  as  cause  of  death  or  disease, 

158. 
Genitals,  of  recruit,  15. 
Genito-urinary  system,  diseases  of 

the ;  relation  of  weights  to  deaths 

from,  5. 
Germicides,  210. 
Germs,  disease-producing,  conve5'ed 

by  meats,  37;  non-destruction  of, 

by  cold,  38. 
Glanders,  transmission  of,  186. 
Goats,  as  carriers  of  tuberculosis, 

190. 
Goggles,  use  of,  in  arctics,  137. 
Gonorrhoea,  286;  complications  of, 

288;  of  eye,  transmission  of,  182; 

prevention  of,  290 ;   transmission 

of,  183,  286. 
Gophers,  as  plague-carriers,  189. 
Gravel,   as   foundation  for  camps, 

78. 
Grits,  occasional  serving  of,  42. 
Gum  trouble,  prompt  report  of,  to 

medical  officer,  26. 
Gums,  10. 
Gymnastics,  as  aid  to  change  of  air 

in  lungs,  20. 

Habits,  as  factor  in  di.sease,  146;  fix- 
ity of,  after  certain  age,  4. 

Ham,  mouldy,  rejection  of,  174. 

Ham,  raw,  danger  in  eating  of,  39. 

Ham-bones,  use  of,  in  soups,  43. 

Hammer-toe,  14. 

Hands,  care  of,  23;  cleanliness  of,  at 
meals,  60;  washing  of,  after  visit 
to  toilet,  64. 

Hard-bread,  41. 

Hat,  campaign,  113,  125. 

Head,  of  recruit,  8. 

Head-gear,  113. 

Head-nets,  use  of,  against  mosqui- 
toes, 271. 

Health  inspections,  230. 

Health,  requisites  for  possession  of, 
203. 


INDEX 


307 


Hearing,  testing  of,  8. 

Heart,  irregularity  of,  due  to  tobac- 
co, 29 ;  organic  diseases  of  the,  rela- 
tion of  weights  to  deaths  from,  5; 
strength  of,  increased  by  exercise, 
21. 

Heart-disease,  due  to  gonorrhoea, 
289. 

Hearts,  weak,  exclusion  from 
marches  of  sufferers  from,  105. 

Heat,  action  of,  on  germs,  207;  prick- 
ly, prevention  of,  128. 

Heat-stroke,  effect  of  alcohol  on, 
106,  124;  predisposed  by  want  of 
water,  107. 

Heating,  57,  59,  C8. 

Hemorrhoids,  7,  8. 

Heredity,  141. 

Hernia,  indication  of,  7;  predisposi- 
tion to,  7;  sites  of,  7. 

Hoarseness,  in  recruit,  10;  tobacco, 
29. 

Hominy,  cooking  of,  in  field,  87;  oc- 
casional serving  of,  42. 

Hood,  over  kitchen  range,  61. 

Hookworm,  126,  165. 

Hope,  as  stimulant,  106. 

Horseback  riding,  hindrance  of,  by 
venereal  cases,  105. 

Horses,  as  carriers  of  anthrax,  191 ; 
as  disease-carriers,  186. 

Hospital  treatment,  advantages  of, 
184. 

Hot-water  heating,  70. 

Houses,  disinfection  of,  254. 

Huts,  as  tent  substitutes,  79. 

Hydrocele,  16. 

Hydrogen,  peroxide,  210. 

Hydrophobia,  transmission  of,  184. 

Hygiene,  golden  rules  of,  31. 

Ice,  as  disease-carrier,  235. 

Ice-chest,  special  scrutiny  of,  52. 

Immunity,  201. 

Immunity,  induced,  255. 

Impetigo,  transmission  of,  182. 

Implements,  as  carriers  of  water- 
borne  diseases,  222. 

Incineration,  human  waste,  92. 

Incubation  periods,  205,  240. 

Indigestion,  causes  of,  87;  indica- 
tion of,  by  condition  of  nose,  9;  in- 
fluence on,  by  neglected  mouth,  25 ; 


severe,  cause  for  rejecting  recruit, 
8. 

Infection,  intestinal,  prevention  of, 
86;  mixed,  of  venereal,  298. 

Infections,  of  camps,  76;  predis- 
posed by  alcohol,  106;  preven- 
tions against,  126;  transmission 
of,  26. 

Influenza,  incubation  period  of,  247; 
relation  of  weights  to  deaths  from, 
5. 

Injuries,  condition  of  mouth  in,  25 ; 
predisposed  by  alcohol,  106. 

Injury,  as  affecting  disease,  147. 

Inoculation,  as  preventative  of  epi- 
demics, 245. 

Insect-borne  diseases,  257. 

Insect-larvaj,  in  cause  of  disease, 
169. 

Insects,  disease-carriers,  76, 192;  poi- 
sonous, protection  from.  111,  126, 
129. 

Insomnia,  due  to  tobacco,  29. 

Inspection,  daily,  of  field  kitchen, 
89;  house-to-house  of  civilians,  99, 
230;  of  person,  58. 

Inspections,  Saturdays',  58. 

Isolation,  of  diseased",  205,  229,  253. 

Itch,  22,  170;  transmission  of,  182. 

Japan,  disease  of,  in  certain  river- 
bottoms,  75. 

"  Jepson  "  urinal,  95. 

Jiggers,  170. 

Juice,  gastric,  bactericidal  action 
of,  200. 

Kerosene,  use  of,  in  urinals,  64. 
Kitchen,  hygiene  of,  .50,  60. 
Kitchens,    ambulance,    110;    camp, 

86. 
Kitchen-waste,  disposal  of,  89. 
Knock-knee,  13. 

Lanterns,  to  mark  night  urinals,  98. 

Larva;,  mosquito,  destruction  of, 
268. 

Latrines,  water-carriage,  92,  96. 

Laundry-work,  facilities  for,  in  bar- 
racks, 65;  facilities  for,  in  camp, 
86. 

Lavatory,  location  of,  57. 

Lead-poisoning,  avoided  by  cleanii- 


308 


INDEX 


ness,  23;  influenced  by  neglected 
mouth,  25. 

Leecbes,  170 ;  protection  from,  126. 

Legs,  of  recruit,  12. 

Leprosy,  indication  of,  14. 

Lice,  22, 170  192;  as  disease-carriers, 
193. 

Lighting,  interior,  56,  59,  67. 

Lime,  chloride,  use  of,  63. 

Line,  cooperation  of,  with  medical 
department,  73. 

Lime-washing,  in  camp,  90. 

Liquids,  as  cause  of  injury  or  death, 
159;  avoidance  of  large  quantities 
with  meals,  24. 

Liver  abscess,  cause  of,  172. 

Liver,  cirrhosis  of,  relation  of 
weights  to  deaths  from,  5 ;  condi- 
tion of,  in  tropics,  123. 

Liver  disease,  indication  of,  7. 

Lockjaw,  cause  of,  176. 

Lumpy-jaw,  transmission  of  cause 
of,  37. 

Lungs,  capacity  of,  increased  by  ex- 
ercise, 21. 

Lymphatics,  of  recruit,  11, 16. 

Macaroni,  42. 

Maggots,  169. 

Malaria,  170, 257 ;  protection  against, 
111,  129;  recurrence  of,  on  marches, 
105;  recurrence  of,  through  alco- 
hol, 278;  relation  of  weights  to 
deaths  from,  5;  transmission  of, 
183,  192,  193. 

Malnutrition,  influenced  by  neg- 
lected mouth,  25. 

Manhood,  misconception  as  to  loss 
of,  27. 

Manners,  table,  59. 

Manoeuvre-camps,  as  guides  to  camp 
craft,  87. 

Marches,  101. 

Marriage,  of  syphilitics,  297. 

Marshes,  vicinity  of,  as  camp-sites, 
76. 

Mastication,  thorough,  60. 

Matches,  as  cause  of  trouble  in 
plumbing,  67. 

Material,  building,  choice  of,  56. 

McCall  incinerator,  92,  97. 

Meals,  hot,  supply  of,  on  the  march, 
110;  time  allowance  for,  21. 


Measles,  incubation  period  of,  247; 
isolation  of,  205;  transmission  of, 
183,  191. 

Measures,  sanitary,  duty  as  to,  not 
ended  by  care  of  self,  101. 

Meat,  tuberculous,  sale  of,  189. 

Meats,  35 ;  fried,  faulty  digestion  as 
result  of,  39. 

Medicines,  speciflc,  211. 

Melancholia,  cause  of,  129. 

Membranes,  mucous,  germ-expel- 
ling function  of,  200. 

Men,  condition  of  the  immature,  3. 

Meningitis,  cerebro-spinal,  247. 

Mercury,  as  speciflc  for  syphilis,  212; 
bichloride,  as  antiseptic,  210. 

Mess,  field  service,  86;  lack  of  va- 
riety in,  cause  of,  40. 

Mess-kits,  washing  of,  in  camp,  83. 

Mess-management,  books  on,  53. 

Mess-room,  59. 

Mice,  as  carriers  of  anthrax,  191 ;  as 
plague-carriers,  130;  prevention  of, 
in  camp,  79. 

Micro-organisms,  effects  of,  in 
"  close  "  rooms,  20;  presence  of,  in 
tents,  77. 

Milk,  43;  as  carrier  of  disease,  193, 
220,  246;  as  carrier  of  scarlet  fever 
and  diphtheria,  193 ;  as  carrier  of 
tuberculosis,  189;  as  cause  of  ty- 
phoid epidemic,  220. 

Milk  cans,  special  scrutiny  of,  52. 

Milk-sickness,  transmission  of  cause 
of,  37,  44. 

Mind,  condition  of,  predisposing  to 
disease,  145. 

Mites,  as  disease-carriers,  193. 

Moisture,  aid  of,  to  bacteria,  177. 

Mosquito,  dengue-infected,  264 ;  ma- 
larial, 260;  yellow  fever,  263. 

Mosquito-borne  diseases,  257. 

Mosquito  brigades,  273. 

Mosquito  nets,  use  of,  in  tropics.  111. 

Mosquito-netting,  use  of,  in  field 
kitchen,  89. 

Mosquitoes,  as  carriers  of  malaria, 
170, 193 ;  breeding  of,  in  fire  buckets, 
71 ;  measures  against,  265 ;  protec- 
tion from,  126,  130,  265 ;  protection 
of,  from  infection,  272. 

Moths,  as  cause  of  disease,  158. 

Moulds,  as  destroyers    of    mosqui- 


INDEX 


309 


toes,    268;    as  disease-producing 

parasites,  174. 
Mouth,  care  of,  25 ;  of  recruit,  9. 
Mucus,  large  amounts  of,  in  feces, 

64. 
MufSns,    baking    of,    by   company 

cooks,  40. 
Mules,  as  disease-carriers,  186. 
Mumps,  incubation  period  of,  247. 
Muscles,  wasting,  causes  of,  13. 
Mush,  corn-meal,  41. 
Mutton,  35. 

Nephritis,  relation  of  weights  to 
deaths  from,  5. 

Nervous  control,  increased  by  exer- 
cise, 21. 

Nervous  system,  relation  of  weights 
to  deaths  from  diseases  of  the,  5. 

Neurasthenia,  cause  of,  129. 

Newspaper,  as  cause  of  trouble  in 
plumbing,  67. 

Night-clothing,  desirability  of,  21. 

Night  urinals,  98. 

Nose,  the,  9. 

Nose,  indicating  alcoholism,  9;  indi- 
cating sjT)hilis,  9.  ,  , 

Notification,  of  epidemic  disease,' 
252,  277. 

Oatmeal,  cooking  of,  in  field,  87. 

Occupation,  diseases  of,  148. 

Officer,  line,  responsibility  of,  for 
pure  water-supply,  81 ;  medical,  as 
authority  on  drinking  water,  109; 
medical,  as  police  officer.  99 ;  medi- 
cal, responsibility  of,  for  pure 
water-supply,  81. 

Officers,  familiarity  of,  with  sanita- 
tion, 73;  of  the  line,  cooperation  of, 
with  medical  officers,  19. 

Oil-cloth,  in  mess  rooms,  59. 

Oil,  crude,  use  of,  against  flies,  94; 
use  of,  against  mosquitoes,  2G9. 

Old  age,  relation  of  weights  to  deaths 
from,  5. 

Oleomargarine,  45. 

Onions,  42. 

Organisms,  disease-producing,  de- 
struction of,  177;  of  air-borne  dis- 
eases, 239. 

Overweights,  ratio  of  deaths  from, 
4,  5. 


Oxygen,  effect  of,  on  endurance, 
104. 

Pail  system,  for  disposal  of  excreta, 
97. 

Paper,  tissue,  issue  of,  64. 

Paralysis,  general,  relation  of 
weights  to  deaths  from,  5. 

Parasites,  large,  162;  minute,  170; 
prevention  of  infestation  of,  108, 
127 ;  transmission  of  infestation  of, 
213  ;  vegetable,  174. 

Paratyphoid,  transmission  of,  37. 

Pasteurization,  177. 

Pastries,  40. 

Pease,  42. 

Peculiarity,  personal,  144. 

Peddlers,  exclusion  of,  from  camp, 
91. 

Penis,  abnormalities  of ,  15;  puffiness 
of,  16;  redness  of,  16;  signs  of  irri- 
tation on,  16;  sores  on,  16;  ulcers 
on,  16. 

Pensions,  possible  grounds  for,  care 
in  noting  them,  19. 

Personal  hygiene,  20. 

Persons,  disinfection  of,  254. 

""est,  the,  see  Plague. 

Petroleum,  use  of,  against  mosqui- 
toes, 269 ;  use  of,  in  camps,  78. 

Pets,  animal,  exclusion  of,  from 
kitchen,  61 ;  from  camps,  78. 

Phenol,  as  antiseptic,  210. 

Physicians,  civilian,  practice  of,  in 
posts,  252. 

Pickling,  as  to  meats,  38. 

Pigs,  as  carriers  of  anthrax,  191;  as 
carriers  of  tuberculosis,  190. 

Piles,  7,  8. 

Pinworm,  165. 

Pipe-smoking,  30. 

Pits,  excreta,  care  of,  94. 

Plague,  infection  of,  126,  129,  273; 
measures  against,  275;  toxin  of, 
179;  transmission  of,  187,  273;  vac- 
cination against,  278. 

Pleurisy,  chronic,  and  chest  type 
in,  6. 

Plumbing,  66;  absence  of,  in  squad- 
rooms,  58;  company  commander's 
familiarity  with,  65;  poor,  of  clos- 
ets indicated  by  bad  odors,  63. 

Pneumonia,  cause  of,  20;  influenced 


310 


INDEX 


by  neglected  mouth,  25;  relation 
of  weights  to  deaths  from,  5; 
transmission  of,  181. 

Poisoning,  metallic,  cause  of,  by 
canned  foods,  46 ;  ptomaine,  causes 
of,  37;  toxic,  influenced  by  neg- 
lected mouth,  25;  wood  alcohol, 
29;  tyrotoxicon,  45. 

Poisons,  as  cause  of  death  or  dis- 
ease, 158 ;  bacterial,  179 ;  vegetable, 
160. 

Police,  as  factor  in  causes  of  disease, 
153;  camp,  99;  in  prevention  of 
epidemics,  206;  in  tropics,  129; 
kitchen,  to  be  rewarded  for  effi- 
ciency, 61 ;  of  camps,  importance 
of,  77;  of  kitchen,  as  punishment, 
52;  on  the  march,  114;  officer,  to 
be  a  medical  officer,  99. 

Poncho,  when  carried.  111. 

Pork,  36. 

Potash,  permanganate,  use  of,  with 
formalin,  209. 

Potatoes,  cooking  of,  in  field,  87; 
cooking  and  serving  of,  41. 

Practice-marches,  as  guides  to  camp 
craft,  87. 

Prairie  dogs,  as  plague-carriers,  189. 

Preservatives,  food,  38. 

Pressure,  air,  as  cause  of  disease, 
158. 

Privies,  danger  of,  to  water-supply, 
83. 

Privileges,  as  reward  for  work  in 
kitchen,  53. 

Problems,  sanitary,  officers'  famil- 
iarity with,  73. 

Prostate,  inflammation  of,  gonor- 
rhoea!, 288. 

Proteids,  33,  122. 

Provost  sergeant,  directed  by  medi- 
cal officer,  99. 

Ptomaine  poisoning,  causes  of,  37. 

Ptomaines,  cause  of,  160. 

Pus,  in  feces,  surgeon  to  be  con- 
sulted, 64. 

Putty,  as  aid  in  exclusion  of  vermin, 
72. 

Quarantine,  205;  as  part  of  camp 
police,  99. 

"  Quarters,"  disadvantage  of  treat- 
ment in,  204. 


Quinine,  as  specific  for  malaria,  212, 

272. 

Rabbits,  as  carriers  of  anthrax,  191. 

Race,  as  factor  in  disease,  146. 

Ration,  for  tropics,  122  ;  full  use  of, 
in  field,  87 ;  increase  of,  in  Alaska, 
133. 

Rations,  army,  books  of  reference 
on,  53. 

Rats,  as  plague-carriers,  130, 188,  273; 
measures  against,  to  prevent  epi- 
demics, 276 ;  prevention  of,  in 
camp,  79 ;  protection  from,  52. 

Ray-fungus,  transmission  of,  37. 

Rays,  actinic,  protection  from,  125. 

Reaction,  prophylactic,  201. 

Recreation-rooms,  58. 

Recruit,  the,  3;  age  limit  for  first 
enlistment,  3 ;  arms  of,  12 ;  bald- 
ness of,  12 ;  character  of,  18 ;  cough 
of,  10 ;  condition  of,  if  immature,  3 ; 
defects  of,  if  noted  by  C.  O.  to  be 
referred  to  medical  officer,  19;  dis- 
proportional  size  of,  4 ;  ears  of,  9 ; 
eyes  of,  8;  feet  of,  12;  fixity  of 
habits  of,  after  certain  age,  4; 
1  ^  genitals  of,  15 ;  head  of,  8 ;  hoarse- 
ness of,  10;  legs  of,  12;  loss  of 
voice  in,  10;  lymphatics  of,  11; 
mouth  of,  9;  nose  of,  9;  presence 
of  vermin  on,  11 ;  proportionate 
weight  and  chest  measurement  of, 
how  published,  4 ;  rejection  of,  on 
account  of  tumors,  7;  rejection 
of,  on  account  of  gallstone  colic, 
8 ;  rejection  of,  on  account  of 
severe  indigestion,  8;  rejection  of, 
on  account  of  vomiting  of  blood, 
8;  scalp  of,  11;  size  of,  4;  skin  of, 
17;  teeth  of,  9, 10;  throat  of,  9, 10; 
tongue  of,  11. 

Reed  trough,  92,  93,  97. 

Reed  Board,  findings  of,  as  to  ty- 
phoid, 213,  215,  219,  222,  225,  227, 
229,  233. 

"  Regulations,  Field  Service,"  ob- 
servation of,  74. 

Reptiles,  protection  from.  111. 

Respiratory  system,  relation  of 
weights  to  deaths  from  diseases  of 
the,  5. 

Rest,  importance  of,  20, 102. 


INDEX 


311 


Rheumatism,  gonorrhcEal,  288. 

Rice,  cooking  of,  in  field,  87;  cook- 
ing and  serving  of,  41. 

Rickets,  deformed  breastbone  as  re- 
sult of,  6. 

Rinds,  ham,  use  of,  in  soups,  42. 

Ringworm,  17;  prevention  of,  128; 
transmission  of,  22,  182,  191. 

Roaches,  as  disease-carriers,  193; 
prevention  of,  in  camp,  79 ;  protec- 
tion from,  52. 

Roads,  state  of,  103. 

Rooms,  56. 

Roundworms,  165. 

Salads,  43. 

Salivation,  mercurial,  influence   of 

neglected  mouth  on,  25. 
Salting,  as  to  meats,  38. 
Salts,  inorganic,  food-value  of,  34; 

urinary,  formation  of,  in  urinals, 

64. 
Sanitation,  desiderata  as  to  supreme 

control  of,  99. 
Scalp,  cleanliness  of,  23 ;  of  recruit, 

11. 
Scarlet  fever,  incubation  period  of, 

247;  isolation  of,  205;  transmission 

of,  44, 181, 191,251. 
Schistosomum  disease,  152, 162. 
Scratching,  signs  of,  17. 
Screening,  of  camp  kitchen,  89. 
Screens,  necessity  of,  57,  59. 
Screw- worms,  169 ;  protection  against 

cause  of.  111. 
Scrotum,  enlargement  of ,  16. 
Scurvy,  133. 
Seasickness,  118. 
Season,  influence  of,  on  epidemics, 

241. 
Seatworm,  165. 
Secretions,  in  causes  of  epidemics, 

244. 
Self-poisoning,  161. 
Self-respect,  indication  of,  by  clean- 
liness, 22. 
Service,  as  a  refuge  after  failure  in 

civil  life,  4. 
Sex,  self-control  of,  in  tropics,  128. 
Sexuallife,27. 
Sheep,  as  carriers  of  tuberculosis, 

190. 
Shelter,  of  camps,  77. 


Shins,  crooked,  13. 

Shirts,  flannel,  use  of ,  in  tropics.  111. 

Shoes,  112;  use  of,  in  tropics,  126. 

Shower-baths,  advantages  of,  over 
tubs,  62;  improvised,  84. 

Sick,  the,  avoidance  of,  204. 

Sickness,  influence  of,  on  marches, 
101,  105. 

Sinks,  kitchen,  care  of,  52. 

Site,  of  ca  m  ps,  74. 

Size,  disproportion  of,  in  the  re- 
cruit, 4. 

Skin,  diseases  of  the,  differentiation 
by  line  oflicers,  17;  diseases  of  the, 
relation  of  weights  to  deaths  from, 
5;  in  causes  of  epidemics,  244;  of 
recruit,  17;  the,  as  a  wall  against 
germ  invasion,  200. 

Skin  diseases,  transmission  of,  by 
domestic  animals,  191;  transmis- 
sion of,  by  toilet  articles,  22. 

Sleep,  amount  of,  21. 

Sleeping,  as  factor  in  cause  of  dis- 
ease, 153. 

Sleeping-sickness,  transmission  of, 
75,  173,  278. 

Slop-buckets,  care  of,  88. 

Smallpox,  bacteria  in,  179;  incuba- 
tion period  of,  247;  isolation  of, 
205 ;  transmission  of,  23,  183,  191 ; 
vaccination  against,  235. 

Smoking,  as  cause  of  exhaustion, 
107;  as  meat  preservative,  .38;  ef- 
fects of,  29 ;  in  day-rooms,  58. 

Snake-venoms,  162. 

Snow-blindness,  136. 

Snow-eyes,  137. 

Soils,  camp-site,  kinds  desirable,  75. 

Sore  throat,  cause  of,  20;  diphtheria 
in,  181;  influenced  by  neglected 
mouth,  25. 

Soup-carts,  field  use  of,  87, 110. 

Spectacles,  wooden,  for  snow-blind- 
ness, 137. 

Spices,  use  of,  in  tropics,  123. 

Spine,  curvature  of,  6. 

Spirilli,  definition  of,  176. 

Spitting,  danger  of,  26;  promiscu- 
ous, by  chewers  of  tobacco,  29,  59. 

Spores,  bacterial,  176. 

Sports,  encouragement  of,  21. 

Spotted  fever,  transmission  of,  19«, 
279. 


312 


INDEX 


Sputum,  disinfection  of,  254;  in 
causes  of  epidemics,  243. 

Squad-rooms,  56. 

Squad,  sanitary,  of  camps,  99. 

Squirrels,  as  carriers  of  plague, 
189. 

Staphylococci,  176. 

Starches  and  sugars,  34. 

Steam-heatiug,  70. 

Stegomyia  fasciata,  carrier  of  yel- 
low fever,  261. 

Sterilization,  207. 

Sterilizer,  Forbes- Waterhouse,  81. 

Store-rooms,  62. 

Stoves,  68. 

Straw,  for  use  in  camps,  78. 

Strength,  muscular,  dependent  on 
heart,  21. 

Streptococci,  176. 

Sublimate,  corrosive,  210. 

Sucking-worms,  162. 

Sugars  and  starches,  34. 

Suggestion,  mental,  for  nervous  dis- 
orders, 126. 

Suicides,  relation  of  weights  to 
deaths  from,  5. 

Sulphur,  as  disinfectant,  208. 

Sunlight,  effect  of,  on  bacteria,  178. 

Sunlight,  strong,  exposure  to,  31. 

Sun-stroke,  predisposed  by  want  of 
water,  107. 

Sun,  consideration  to,  in  placing 
buildings,  55. 

Suppuration,  germs  of,  194. 

Surra  and  sleeping  sickness,  rela- 
tion of,  173. 

Susceptibility,  to  water-borne  dis- 
eases, 219. 

Swamps,  malarial,  76. 

Sweets,  47. 

Swimming,  127. 

Syphilis,  173,  183,  292;  fourth  stage 
of,  296;  in  company  cook,  51 ;  indi- 
cated by  condition  of  nose,  9 ;  in- 
dications of,  9,  10,  11, 12, 14,  17;  in- 
fluenced by  neglected  mouth,  25; 
prevention  of,  297;  primary  and 
secondary,  295;  tertiary,  296. 

Syringes,  rectal,  as  disease-carriers, 
222. 

Tapeworms,  163;  transmission  of,  37. 
Tea,  47 ;  on  the  march,  109. 


Teeth,  care  of,  25;  loss  of,  25;  of  re- 
cruit, 9-10. 

Temperature,  demands  of,  as  to 
clothing  worn,  30;  in  causes  of  dis- 
ease, 158. 

Tendon,  inflammation  of,  gonor- 
rhceal,  288. 

Tents,  77. 

Testicles,  condition  of,  15. 

Tests,  for  purity  of  water,  82. 

Tetanus,  cause  of,  176. 

Throat,  of  recruit,  9,  10. 

Trough,  Reed,  92,  93,  97. 

Thumb,  loss  of,  12. 

Tick  fever,  193. 

Ticks,  170,193;  as  carriers  of  disease, 
74,  75,  193,  279;  protection  against, 
111,  126. 

Tin  cans,  disposal  of,  in  field,  89. 

Toasting,  bread,  40. 

Tobacco,  29. 

Toilet  articles,  exclusive  ownership 
of,  62;  transmission  of  disease  by, 
22. 

Toilet-paper,  camp  use  of,  94. 

Tongue,  of  recruit,  11. 

Tonsillitis,  incubation  period  of,  247. 
transmission  of,  182. 

Tonsils,  enlargement  of,  10. 

Tooth-brush,  use  of,  26. 

Tooth-trouble,  prompt  report  of,  to 
medical  officer,  26. 

Towel,  care  of,  in  field,  113. 

Towels,  liberal  use  of,  by  company 
barber,  62. 

Toxins,  bacterial,  179. 

Traflic,  regulated  by  camp  police, 
99. 

Training,  lack  of,  as  cause  of  dis- 
ease, 146. 

Transportation  facilities,  effect  of, 
on  marches,  103. 

Transports,  117. 

Trappings,  useless,  exclusion  of, 
from  squad-rooms,  58. 

Traumatism,  156. 

Trembles,  in  cattle,  transmission  of, 
cause  of,  37. 

Tremor,  tobacco,  29. 

Trenches,  in  disposal  of  wastes,  93, 
96. 

Treponema,  173. 

Trichina,  transmission  of,  37. 


INDEX 


313 


Trichiniasis,  167. 

"  Trikresol,"  as  disinfectant,  211. 

Troop  trains,  118. 

Troops,  assemblage  of,  danger  in,  73; 
moving,  bygiene  of,  101. 

Tropics,  clothing  in.  111. 

Tuberculosis,  indication  of,  14;  in- 
rtuenced  by  neglected  moutb,  25; 
in  company  cook,  51;  relation  of 
weights  to  deaths  from,  5;  toxin 
of,  179 ;  transmission  of,  26,  37,  44, 
182,  189,  193. 

Tumors,  as  cause  for  rejection  of  re- 
cruit, 7. 

Typhoid,  as  camp  disease,  76;  cause 
of, 214;  death  rate  of,  219;  destruc- 
tion of  organism  of,  80 ;  isolation 
of,  205,  229;  milk-borne  epidemics 
of,  220;  transmission  of,  22,  23,  26, 
37,  44,  51,  98,  108,  127,  182,  183,  193, 
213 ;  relation  of  weights  to  deaths 
from,  5;  toxin  of,  179;  vaccination 
against,  236. 

Typhus,  incubation  period  of,  247; 
transmission  of,  252. 

Tyrotoxicon,  development  of,  45. 

Ulcers,  in  throat  of  recruit,  10 ;  on 
penis,  16;  on  leg  of  recruit,  13. 

Underclothing,  care  of,  on  the 
march,  113;  kind  for  tropics,  125; 
not  to  be  slept  in,  21. 

Underweights,  table  of  death  rate 
of,  4,  5. 

Urethra,  contents  of,  15. 

Urinals,  64,  67,  97. 

Urination,  careless,  danger  of,  20; 
near  tents  in  camp,  79. 

Urine,  antiseptic  action  of,  201; 
cause  of  insufticiency  of  water  on 
the,  107;  disposal  of,  to  prevent 
epidemics,  233;  flowing  of,  17;  hu- 
man, disposal  of,  in  camp,  91. 

Urine  pit,  importance  of,  95. 

Utensils,  as  carriers  of  epidemic  dis- 
ease, 245;  disinfection  of,  2r)4;  bar- 
ber's, sterilization  of,  61 ;  kitchen, 
cleanliness  of,  in  field,  88. 

Vaccination,  against  epidemic  dis- 
ease, 236,  255,  278. 
Varicocele,  16. 
Veal,  36. 


Vegetables,  41 ,  152 ;  as  carriers  of  ty- 
phoid, 221;  as  cause  of  intestinal 
diseases,  122;  control  of  sale  of, 
during  epidemics,  236;  underdone, 
as  cau.se  of  indigestion,  87. 

Veins,  dilated,  of  leg,  13;  distended 
abdominal,  cause  for  rejection  of 
recruit,  7;  varicose,  of  abdomen, 
cause  for  rejection  of  recruit,  7; 
varicose,  of  leg,  13. 

Venereal,  281. 

Venereal  disease,  veracity  as  to,  in 
recruits,  17. 

Ventilation,  56,  59,  68,  78,  204,  250;  In 
arctics,  131;  in  prevention  of  epi- 
demics, 204. 

Vermin,  as  cause  of  epidemics,  223; 
destruction  of,  by  sulphur,  208; 
elimination  of,  to  prevent  epidem- 
ics, 233,  252;  exclusion  of,  from 
kitchen,  etc.,  52,  55,  71,  129;  on  re- 
cruit, 11,  10,  17,  22;  spread  of,  in 
camps,  78. 

Violence,  relation  of  weight  to  deaths 
from,  5. 

Vision,  testing  of,  8. 

Vitality,  influence  of  weight  on,  4, 5. 

Voice,  loss  of,  in  recruit,  10. 

Voit,  food-standard  of,  35. 

Vomit,  disposal  of,  to  prevent  epi- 
demics, 233. 

Walls,  damp,  avoidance  of,  55. 

"  Warbles,"  169. 

Warts,  venereal,  16. 

Waste,  channels  of  excretion  of,  af- 
fected by  exercise,  21 ;  disposal  of, 
in  camp,  91. 

Waste  water,  disposal  of,  in  camp, 
85;  kitchen,  disposal  of,  in  camp, 
89. 

Water,  boiling,  for  dilution  of  milk, 
45;  use  of,  as  vermin  killer,  72. 

Water,  food-value  of,  35;  steriliza- 
tion of,  in  camp,  80. 

Water-carriage  latrines,  92. 

Water-closets,  57,  63. 

Water-supply,  65,  80,  106, 121,  251 ;  as 
disease-carrier,  26,  98,  150,  193,  219, 
235;  in  arctics,  132. 

Weather,  influence  of,  on  marches, 
101 ;  protection  from  inclemencies 
of,  80.     • 


314 


INDEX 


Weight,  carried  on  marches,  103. 

Weight  and  chest  measurements  for 
recruits,  publication  of,  4. 

"  Wet  dreams,"  27. 

Whipworm,  165. 

Whooping-cough,  incubation  period 
of,  247;  transmission  of ,  191. 

Wind,  regard  to,  in  placing  build- 
ings, 55. 

Windows,  storm,  57;  variable  needs 
of,  66. 

Winds,  value  of,  in  camps,  76. 


Wire-gauze,  use  of,  in  field  kitchen, 
89. 

Wolf,  as  carrier  of  hydrophobia,  184, 

Wool-sorters'  disease,  191. 

Worms,  as  animal  parasites,  162; 
intestinal,  transmission  of,  182 ;  in 
feces,  surgeon  to  be  consulted,  64. 

Yaws,  173. 

Yeasts,  as  agents  of  disease,  174 
Yellow  fever,  192,  260;  isolation  of, 
205;  protection  against,  111,  129. 


CAMBRIDGE  .  MASSACHUSETTS 
U    •    S    .    A 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


AA    000  930  395    9 


CENTRAL  UNIVERSITY  LIBRARY 
University  of  California,  San  Diego 

DATE  DUE 


JUN  3  Q  1977 
M.^  1 1995 


MTFRI 


'■/) 


wt 


•Ah 


CI  39 


UCSD  Libr. 


